Note: The job is a remote job and is open to candidates in USA. PharMerica is a long-term care pharmacy services provider serving healthcare organizations across the United States. The Medicare D Billing Representative coordinates prior authorizations, researches payment denials, communicates with facilities, pharmacists, physicians, and prescription drug plans, and ensures accurate documentation and resolution of authorization requests.
Responsibilities
- Act as a resource to the facilities in obtaining information completing necessary documentation or following up on outstanding claims
- Individual with an understanding of Insurance and Medicaid formularies and processes including the prior authorization processes
- Makes outgoing calls to Facilities, Plans, and Physician’s offices as needed to obtain approvals
- Works with Client Billing Service Offices, Pharmacy Directors, customers and prescription drug plans to effectively communicate and resolve customer issues
- Performs other tasks as assigned
- Achieves 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
- Conducts 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
- Familiar with the claim adjudication process
- 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
Skills
- The ideal candiate will be a Certified Pharmacy Technician or Medical Assistant Certification (desired) and have Third party Medical Billing experience
- Remote: May reside anywhere with the Continental USA
- No matter what time zone in which you reside, you must be able to work Central Time Zone hours
- Schedule: Monday - Friday 11am - 7:30pm CENTRAL Time Zone
- * Individual with an understanding of Insurance and Medicaid formularies and processes including the prior authorization processes
- * Familiar with the claim adjudication process
- * High School Diploma, Associates degree
- * Third party Medical Billing experience
- * EMAR system knowledge
- * Understanding of insurance and medicaid formularies and processes including the prior authorization processes
- * Familiar with the claim adjudication process
- * Proficiency in Microsoft Office programs
- * Prioritize work to meet daily and competing deadlines
- * Bachelor's degree preferred
- * Certified Pharmacy Technician or Medical Assistant Certification desired
- * One to three years of pharmacy experience preferred
- * Three years of call center experience preferred
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
- Remote work; may reside anywhere with the Continental USA
Company Overview