[Hiring] Medicare D Billing Representative @BrightSpring Health Services

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 and coordinating with facilities to obtain supporting information.
• Updating and documenting prior authorizations, including clinical justifications, while ensuring the accurate and timely completion of all required authorization forms.
• Maintaining a high level of attention to detail when initiating, processing, and tracking prior authorizations on behalf of customers.
• Working closely with EMAR systems, healthcare facilities, and clinical teams to ensure efficient coordination, thorough documentation, and successful resolution of authorization requests.

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

• Remote: May reside anywhere within the Continental USA.
• Must be able to work Central Time Zone hours.
• Schedule: Monday - Friday 11am - 7:30pm Central Time Zone.

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.