Medicare D Billing Representative

PharMerica•Lyndon, KY

1d•Remote

About The Position

PharMerica, part of BrightSpring Health Services, is a long-term care pharmacy services provider. The Medicare D Billing Representative serves as a primary liaison for the Clinical Hub and communicates with pharmacists, healthcare facilities, physicians, and Prescription Drug Plans about therapeutic interchange opportunities and prior authorization requests. The role researches payment denials by contacting insurance plans to determine their causes and coordinates with facilities to obtain supporting information. The representative initiates, processes, tracks, updates, and documents prior authorizations, including clinical justifications, and ensures authorization forms are completed accurately and on time. Working with EMAR systems, healthcare facilities, and clinical teams, the representative coordinates the authorization process, maintains thorough documentation, and helps resolve requests efficiently. The role also supports insurance verification, claim adjudication, back-end billing, and insurance queue workflows. This is a remote position available to applicants residing in the continental United States. Employees must be able to work Central Time Zone hours: Monday through Friday, 11:00 a.m. to 7:30 p.m. Central.

Requirements

High school diploma; an associate degree is also listed, and a bachelor’s degree is preferred.
Third-party medical billing experience.
Knowledge of EMAR systems.
Understanding of insurance and Medicaid formularies and processes, including prior authorization processes.
Familiarity with the claim adjudication process.
Proficiency in Microsoft Office programs.
Ability to prioritize work to meet daily and competing deadlines.
Ability to work Monday through Friday, 11:00 a.m. to 7:30 p.m. Central Time.

Nice To Haves

Certified Pharmacy Technician or Medical Assistant certification.
One to three years of pharmacy experience.
Three years of call center experience.
Bachelor’s degree.

Responsibilities

Act as a resource to facilities by obtaining information, completing necessary documentation, and following up on outstanding claims.
Make outgoing calls to facilities, plans, and physicians’ offices as needed to obtain approvals.
Work with Client Billing Service Offices, Pharmacy Directors, customers, and prescription drug plans to communicate about and resolve customer issues.
Provide clinical support to RxAllow team members regarding prior authorization concerns and submissions.
Achieve productivity goals for calls and claims per hour as determined by the Director and Clinical Hub Manager.
Develop a strong understanding of insurance verification, adjudication, back-end billing, insurance queues, and billing workflows.
Perform other tasks as assigned.
Conduct job responsibilities in accordance with the Company’s Code of Business Conduct and Ethics, policies and procedures, Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.