Medicare D Billing Representative

PharMerica

Hybrid

PharMerica is seeking a Medicare D Biller.

This vital role serves as a key point of contact for the Clinical Hub and proactively communicates with Pharmacists, Facilities, Physicians and PDP's regarding Therapeutic Interchanges and prior authorization requests. Responsible for investigating and calling plans to determine the reasons for payment denials and Facilities to provide the reasons for denial, while updating and documenting prior authorizations with clinical justifications. To provide high level of attention to detail while initiating and completing the Prior Authorization forms for our customers. Working with EMAR systems, as well as, facilities and serving as key contact for the completion of Prior Authorizations.

This is an Hybrid position in Arlington, TX, where some days are spent in your home office and others on-site

Hours are 9:00am - 5:30pm

What We Offer:

Benefits start on the 1st day of the month following 30 days of employment (Health, dental, vision, and life insurance).
• Mileage Reimbursement - We cover your travel costs.
• Flexible Schedules - Work around your lifestyle.
• Paid Time Off & 6 Company Holidays - Recharge and enjoy your time off.
• Competitive Pay - Your skills are rewarded.
• Company-Paid Disability Insurance - Both short-term and long-term.
• 401k Plan - Secure your future with our retirement plan.
• Tuition Reimbursement - Advance your education with our support.
• Employee Discount Program - Enjoy perks that extend beyond the workplace.

*Position will be posted for a minimum of 7 business days

• 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

• High School Diploma, Associates degree; 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
• Prioritize work to meet daily and competing deadlines