[Hiring] 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. The Medicare D Biller serves as a key point of contact throughout the prior authorization process, ensuring:

• Efficient coordination.
• Thorough documentation.
• Successful resolution of authorization requests.

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.

Qualifications

• High School Diploma; Associate's 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 and 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.