Pharmacy Billing Specialist Resume Example

Pharmacy Billing Specialist · Rush University Medical Center - Outpatient Specialty Pharmacy

Chicago, IL · 2022 - Present

• Managed end-to-end billing for high-cost specialty medications, processing an average of 60 prior authorization requests weekly with a 95% approval rate.
• Successfully appealed 85% of initially denied claims, recovering over $150,000 in reimbursements for complex patient cases over 18 months.
• Collaborated with clinical teams and manufacturers to secure patient assistance program enrollment, improving patient adherence by 20% for critical therapies.
• Streamlined benefit verification process using payer portals, reducing initial claim submission time by 15% and increasing clean claim rate to 98%.

Pharmacy Billing Assistant · Advocate Aurora Health - Outpatient Pharmacy

Chicago, IL · 2021 - 2022

• Processed and submitted an average of 100 outpatient pharmacy claims daily, achieving a 99% accuracy rate for initial data entry.
• Verified patient insurance coverage and eligibility, preventing an average of 15-20 claim rejections per week due to incorrect information.
• Assisted in resolving billing discrepancies and insurance rejections, contributing to a 10% reduction in outstanding accounts receivable.
• Maintained meticulous records of billing transactions and patient communications, ensuring HIPAA compliance and data integrity.

Bachelor of Science in Health Information Management · DePaul University

Chicago, IL · 2018 - 2022

• Graduated Magna Cum Laude with a GPA of 3.8/4.0
• Completed capstone project on optimizing revenue cycle management in specialty pharmacy
• Relevant coursework included Medical Terminology, Healthcare Reimbursement, and Health Informatics

Pharmacy Billing Specialist · Walgreens Specialty Pharmacy

Philadelphia, PA · 2023 - Present

• Managed a daily caseload of 50+ complex pharmacy claims for specialty medications, ensuring accurate submission and timely reimbursement.
• Successfully reduced claim rejection rates by 12% within the first six months through meticulous data verification and proactive communication with insurance providers.
• Utilized RxClaim and Frameworks software to process prior authorizations and resolve billing discrepancies, improving claim resolution time by 20%.
• Collaborated with pharmacists and patient care teams to address billing inquiries and provide comprehensive benefit explanations to patients, enhancing patient satisfaction.
• Identified and rectified billing errors to prevent revenue loss, contributing to a 5% increase in clean claim submissions.

Medical Administrative Assistant · Penn Medicine

Philadelphia, PA · 2022 - 2022

• Coordinated appointments and managed patient records for a busy internal medicine practice, serving an average of 30 patients daily.
• Processed patient demographics and insurance information with 99% accuracy, significantly reducing front-end billing errors.
• Handled initial insurance verification and co-pay collection, contributing to a 10% improvement in point-of-service collections.
• Maintained strict HIPAA compliance while handling sensitive patient data and communications, safeguarding patient privacy.
• Streamlined patient intake processes by implementing a new digital check-in system, decreasing average wait times by 7 minutes per patient.

Bachelor of Science in Health Administration · Temple University

Philadelphia, PA · 2018 - 2022

• Graduated Magna Cum Laude with a GPA of 3.8/4.0
• Completed capstone project on optimizing patient access workflows, presenting findings to local clinic management