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medicare d billing representative
2 weeks ago
PharMerica
Join our PharMerica team PharMerica is a closed-door pharmacy where you can focus on fulfilling the pharmaceutical needs of our long-term care and senior living clients. We offer a non-retail pharmacy environment. Our organization is in high growth mode, which means advancement opportunities for individuals who are looking for career progression
We offer:
DailyPay
Flexible schedules
Competitive pay
Shift differential
Health, dental, vision and life insurance benefits
Company paid STD and LTD
Tuition Assistance
Employee Discount Program
401k
Paid-time off
Tuition reimbursement
Non-retail/Closed-door environment
Our Pharmacy group focuses on providing exceptional customer service and meeting the pharmacy needs for hospitals, rehabilitation hospitals, long-term acute care hospitals, and other specialized care centers nationwide. If your passion is service excellence and top-quality care come join our team and apply today
- Acts as a resource to the facilities in obtaining information, completing necessary documentation, and following up on outstanding claims.
- Understands 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.
- Provides clinical support to members of the RxAllow team regarding prior authorization concerns
- Achieves productivity goals with regard to calls/claims per hour, as determined by the Director and Clinical Hub Manager.
- Prioritizes work to meet daily and competing deadlines.
- Develops 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.
- Maintains a clean and organized work area.
- Performs other tasks as assigned.
Education/Learning Experience:
- Required: HS Diploma or equivalent experience.
- Desired: Associate degree/ Bachelor's Degree.
Work Experience:
- Required: Third Party Medical Billing Experience.
- Desired: 1-3 years pharmacy experience; 3 years call center experience.
Skills/Knowledge:
- Required: Familiar with the claim adjudication process. Proficiency in Microsoft Office.
- Desired: Understanding of the insurance verification, adjudication, back-end billing process and become a subject matter expert on the insurance queues and billing workflow.
Licenses/Certifications:
- Required: Certified Pharmacy Technician.
Behavior Competencies:
- Required: Interpersonal Skills, Oral Communication, Written Communication, Teamwork, Ethics, Organizational Support, Judgment, Planning/Organizing, Professionalism, Adaptability, Initiative.
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