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Medicare D Billing Representative

4 months ago

Arlington, United States Res-Care, Inc. Full time

Our Company

PharMerica

Overview

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

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

Qualifications

* 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

About our Line of Business

PharMerica is a full-service pharmacy solution providing value beyond medication. PharMerica is the long-term care pharmacy services provider of choice for senior living communities, skilled nursing facilities, public health organizations and post-acute care organizations. PharMerica is one of the nation's largest pharmacy companies. PharMerica offers unmatched employee development, exceptional company culture, seemingly endless opportunities for advancement and the highest hiring goals in decades. For more information about PharMerica, please visit www.pharmerica.com. Follow us on Facebook, Twitter, and LinkedIn.