Remote Medical Auditor Jobs in Boca Raton, FL (NOW HIRING)

WHO WE ARE
At Polaris Pharmacy Services, we're more than a pharmacy - we're a dedicated partner in care, transforming how patients experience long-term, post-acute, correctional, PACE, and specialty pharmacy services. As industry leaders, we're raising the bar for quality and coordination across all sites of care, ensuring every patient receives seamless, compassionate, and expert support.
Founded in 2015, Polaris is proud to be locally and independently owned, with a growing national footprint. Our team thrives in a mission-driven environment where innovation meets purpose, and every role contributes to making a real impact. We offer more than just a job - we provide competitive pay, robust benefits, and genuine opportunities for career advancement.
If you're passionate about shaping the future of pharmacy and making a difference in the lives of those who need it most, we invite you to grow with us.
Job Purpose
The Medicaid Pending Billing Specialist at POLARIS PHARMACY SERVICES is responsible for managing the billing process for Medicaid pending claims, ensuring timely resolution and rebilling. This role requires a detail-oriented professional who can effectively liaise with various stakeholders to facilitate appeals and provide financial assistance, while maintaining accurate documentation throughout the process.
Key Responsibilities:

• Manage the pending queue for Medicaid claims, ensuring all claims are processed efficiently and accurately.
• Resolve claim issues by identifying discrepancies and implementing solutions to facilitate timely payments.
• Rebill Medicaid claims as necessary, ensuring compliance with relevant regulations and guidelines.
• Serve as a liaison between POLARIS PHARMACY SERVICES and Medicaid representatives, facilitating communication and resolution of billing issues.
• Handle appeals processes, working to overturn denied claims and secure payment.
• Provide financial assistance guidance to patients and families, helping them navigate the complexities of Medicaid billing.
• Maintain thorough and accurate documentation of all billing activities, ensuring records are up-to-date and accessible for auditing and reporting purposes.

QUALIFICATIONS/COMPETENCIES:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Required Skills and Abilities:

• Strong knowledge of Medicaid billing procedures and regulations.
• Excellent organizational skills with the ability to manage multiple tasks and priorities effectively.- Proficiency in using billing software and Microsoft Office Suite, including Excel and Word.
• Strong analytical skills with attention to detail in documentation and claim resolution.
• Effective communication skills to liaise with various stakeholders, including patients, insurance companies, and internal departments.
• Ability to work independently and collaboratively in a fast-paced environment.
• Problem-solving skills with a proactive approach to resolving billing issues and claims efficiently.

Required Education:
- High school diploma or equivalent; an associate or bachelor's degree in healthcare administration, finance, or a related field is preferred.
Required Experience:
- Minimum of 2 years of experience in medical billing, preferably with Medicaid.
- Proven experience in managing pending queues and resolving claims.
- Experience in working with financial assistance programs and understanding of appeals processes.
PHYSICAL DEMANDS
The physical demands described here are representative of those that should be met by an employee to successfully perform the essential functions of this job:

• May sit or stand seven (7) to ten (10) hours per day
• The employee is occasionally required to sit; climb or balance; and stoop, kneel, bend, walk
• May be necessary to work extended hours as needed
• May lift and/or move up to 30 pounds
• The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this role

HOLIDAY & PTO POLICY

• Paid holidays are provided annually, with 6 days offered each year, along with 5 sick days.
• Employees earn up to 10 PTO days each year, with rollover options and milestone bonuses.
• Employees have the option to cash out up to 10 PTO hours each quarter for added financial flexibility.

Please note, because we are a pharmacy most of our locations are open 24-hours a day, 7 days a week and therefore schedules may change as determined by the needs of the business.
BENEFITS for full time Employees

• Medical, Dental, and Vision insurance
• 401 (k) (available for Part Time & Full Time EEs)
• Company Paid Life insurance
• Short-term and Long-term disability insurance
• Tuition reimbursement
• Personal Time Off (PTO)
• Competitive pay with annual performance reviews and merit-based raises
• Career growth potential
• Annual on-site voluntary Flu Vaccines
• Employee referral bonus program