Execute monthly billing processes, including enrollment and disenrollment updates, data validation, and invoice preparation.
Review and reconcile client census counts and supporting billing inputs to ensure completeness and accuracy.
Generate and distribute invoices in accordance with contractual terms and internal controls.
Review vendor-related charges (e.g., courier invoices) and ensure appropriate client billing allocation.
Support resolution of pharmacy billing issues, including rebills, claim rejections, and insurance discrepancies.
Partner with operational teams and network pharmacies to investigate and resolve PBM and billing issues.
Process and document billing adjustments, including medication return credits.
Prepare billing schedules and documentation to support internal reviews and external audits.
Assist with onboarding new clients or transitions of services to ensure billing continuity.
Assist with audits, including annual PACE audits, quarterly PBM audits, and other internal or external reviews.

High School diploma or equivalent required.
2+ years of experience in healthcare billing, pharmacy operations, revenue cycle, or related financial operations required.
Experience supporting PACE programs or PBM billing preferred.
Strong understanding of billing operations and revenue cycle workflows.
Excellent analytical and problem-solving skills with high attention to detail.
Strong organizational and time management skills; able to manage multiple priorities in a deadline-driven environment.
Effective verbal and written communication skills; able to collaborate cross-functionally and communicate clearly with operational stakeholders.
High degree of ownership, accountability, and follow-through.
Proficiency in Excel and comfort working across multiple systems and billing platforms.
Ability to operate independently while contributing collaboratively in a dynamic environment.

Billing Specialist

Key skills