PharMerica, an affiliate of BrightSpring Health Services, delivers personalized pharmacy care through dedicated local teams, serving health care providers such as skilled nursing facilities, senior living communities, and hospitals. We also cater to individuals with behavioral needs, infusion therapy needs, seniors receiving in-home care, and patients with cancer. Operating long-term care, home infusion, and specialty pharmacies across the nation. Combines the personal touch of a neighborhood pharmacy with the resources of a national network. Comprehensive solutions, backed by industry-leading technology and regulatory expertise, ensure accurate medication access, cost control, and compliance with best-in-class clinical standards. Committed to enhancing resident health, reducing staff burdens, and supporting our clients' success.
Medicare D Billing Representative
Location
United States
Posted
1 day ago
Salary
0
Seniority
Mid Level
No structured requirement data.
Job Description
Medicare D Billing Representative
PharMerica
Role Description The Medicare D Biller serves as a primary liaison for the Clinical Hub, maintaining proactive communication with pharmacists, healthcare facilities, physicians, and Prescription Drug Plans (PDPs) regarding therapeutic interchange opportunities and prior authorization requests. This role is responsible for: - Researching payment denials by contacting insurance plans to determine the cause of denials. - Coordinating with facilities to obtain supporting information. - Updating and documenting prior authorizations, including clinical justifications. - Ensuring the accurate and timely completion of all required authorization forms. The position requires a high level of attention to detail when initiating, processing, and tracking prior authorizations on behalf of customers. Responsibilities include: - Working closely with EMAR systems, healthcare facilities, and clinical teams. - Serving as a key point of contact throughout the prior authorization process. - Ensuring efficient coordination, thorough documentation, and successful resolution of authorization requests. Remote work is available, with the requirement to work Central Time Zone hours. The schedule is Monday - Friday, 11am - 7:30pm Central Time Zone. Qualifications - High School Diploma; Associates degree preferred; Bachelor's degree preferred. - Certified Pharmacy Technician or Medical Assistant Certification desired. - Third party Medical Billing experience. - EMAR system knowledge. - One to three years of pharmacy experience preferred. - Three years of call center experience preferred. - Understanding of insurance and Medicaid formularies and processes including the prior authorization processes. - Familiar with the claim adjudication process. - Proficiency in Microsoft Office programs. - Ability to prioritize work to meet daily and competing deadlines. Requirements - Act as a resource to the facilities in obtaining information, completing necessary documentation, or following up on outstanding claims. - Make outgoing calls to facilities, plans, and physician’s offices as needed to obtain approvals. - Work with Client Billing Service Offices, Pharmacy Directors, customers, and prescription drug plans to effectively communicate and resolve customer issues. - Perform other tasks as assigned. - Achieve productivity goals with regard to calls/claims per hour as determined by the Director and Clinical Hub Manager. - Provide clinical support to members of the RxAllow team regarding prior authorization concerns/submissions. - Conduct job responsibilities in accordance with the standards set out in the Company’s code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards. - Develop a strong understanding of the insurance verification, adjudication, back-end billing process, and become a subject matter expert on the insurance queues and billing workflow. Benefits - Medical, Dental, Vision insurance. - Health Savings & Flexible Spending Accounts (up to $5,000 for childcare). - Tuition discounts & reimbursement. - 401(k). - Company Paid Time Off. - Shift Differential. - DailyPay. - Pet Insurance. - Employee wellness and discount programs.
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