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Pharmacy Claims Technician
2 weeks ago
Claims Technician -- Horizon LTC Pharmacy
Full-Time | Grand Rapids, MI
Are you someone who loves accuracy, enjoys solving billing puzzles, and wants to work where your attention to detail truly makes a difference? Horizon LTC Pharmacy is looking for a full-time Claims Technician to join our growing long-term care pharmacy team.
At Horizon LTC, we pride ourselves on supporting residents, facilities, and care teams with fast, reliable, and compassionate service. As part of our team, you'll be surrounded by a supportive network and a company committed to high-quality, patient-centered care.
Our mission is simple: optimize the quality of life through personalized pharmacy solutions. And we live by our core values: be a team player, be professional, be positive, get better, and put the customer first. If those resonate with you, keep reading
What You'll Do
You'll play a key role in keeping our billing workflow running smoothly every single day. Your responsibilities will include:
- Processing and submitting daily prescription claims in real time
- Monitoring and clearing billing queues to maintain workflow
- Managing recurring billing cycles for long-term care and institutional patients
- Handling timely, accurate bulk claims tied to cycle fill schedules
- Creating, monitoring, and managing billing batches within our pharmacy systems
- Reviewing batch exceptions and resolving issues quickly
- Identifying rejected claims and navigating the prior authorization process
- Working with providers and payers to gather prior authorization documentation and reprocess claims
- Updating billing records when patients are admitted, discharged, or have insurance or level-of-care changes
- Prioritizing first-dose and urgent claims to support immediate patient needs
- Communicating and collaborating with our pharmacy team on time-sensitive billing issues
- Supporting the team with additional tasks as needed
What You'll Bring
We're looking for someone who can combine technical know-how with a strong sense of responsibility:
- High School Diploma or equivalent
- Michigan Pharmacy Technician License (required)
- 1-2 years of pharmacy billing or healthcare claims processing experience
- Experience with the pharmacy billing platforms like FrameworkLTC or QS/1
- Solid understanding of Medicaid, Medicare Part D, and private insurance
- Strong problem-solving ability when it comes to claim rejections and PA issues
- Excellent attention to detail, communication, and time management
- A commitment to patient confidentiality
Why You'll Love Working at Horizon LTC
At Horizon LTC Pharmacy, you're not just joining a pharmacy--you're joining a team that cares deeply about the patients and facilities we serve. Your work directly ensures that residents receive the medications they need--on time, every time. And that means your role truly matters. If you want to put your billing skills to work in a mission-driven pharmacy setting, this could be the perfect opportunity.
If you're ready to grow your career with a supportive long-term care pharmacy team, we'd love to meet with you
