Job description
Our Company
PharMerica
Overview
PharMerica, a part of Brightspring Health Services, is a long‑term care pharmacy services provider that supplies medications, clinical support, and pharmacy management to healthcare organizations across the United States.
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.
The ideal candiate will be a Certified Pharmacy Technician or Medical Assistant Certification (desired) and have Third party Medical Billing experience
Remote: May reside anywhere with the Continental USA.
No matter what time zone in which you reside, you must be able to work Central Time Zone hours
Schedule: Monday - Friday 11am - 7:30pm CENTRAL Time Zone
Benefits and perks for You!
Medical, Dental, Vision insurance
Health Savings & Flexible Spending Accounts (up to $5,000 for childcare)
Tuition discounts & reimbursement
401(k)
Company Paid Time Off*
Shift Differential
DailyPay
Pet Insurance
Employee wellness and discount programs
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, an affiliate of BrightSpring Health Services, delivers personalized pharmacy care through dedicated local teams, serving health care providers such as skilled nursing facilities, senior living communities, and hospitals. We also cater to individuals with behavioral needs, infusion therapy needs, seniors receiving in-home care, and patients with cancer. Operating long-term care, home infusion, and specialty pharmacies across the nation, we combine the personal touch of a neighborhood pharmacy with the resources of a national network. Our comprehensive solutions, backed by industry-leading technology and regulatory expertise, ensure accurate medication access, cost control, and compliance with best-in-class clinical standards. We are committed to enhancing resident health, reducing staff burdens, and supporting our clients' success. For more information, visit www.pharmerica.com. Follow us on Facebook, Twitter, and LinkedIn.Originally posted on Himalayas
Who can apply
Eligible countries: United States. Accepted UTC offsets: UTC-10, UTC-9, UTC-8, UTC-7, UTC-6, UTC-5, UTC+14. Review the full description for employer-specific work authorization, residency and schedule requirements.