Medicare D Billing Representative

PharMerica•Lyndon, KY

4d•Remote

About The Position

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. Additionally, the Medicare D Biller updates and documents prior authorizations, including clinical justifications, while 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. Working closely with EMAR systems, healthcare facilities, and clinical teams, the Medicare D Biller serves as a key point of contact throughout the prior authorization process, ensuring efficient coordination, thorough documentation, and successful resolution of authorization requests.

Requirements

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

Nice To Haves

Certified Pharmacy Technician or Medical Assistant Certification

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