PharMerica
OverviewJoin 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!
The Medicare D Billing Representative serves as a key point of contact for the Clinical Hub and proactively communicates with Pharmacists, Facilities, Physicians and PDP’s regarding Therapeutic Interchanges and prior authorization requests. Responsible for investigating and calling plans to determine the reasons for payment denials and Facilities to provide the reasons for denial, while updating and documenting prior authorizations with clinical justifications. To provide high level of attention to detail while initiating and completing the Prior Authorization forms for our customers. Working with EMAR systems, as well as, facilities and serving as key contact for the completion of Prior Authorizations. NOTE: pharmacy experience preferred
This is a hybrid position. Applicants must reside in, or a commutable distance to Arlington, TX and will work onsite 3 days per week.
Schedule:
Monday - Friday 9:30am - 6:00pm Central Time
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 claimsIndividual with an understanding of Insurance and Medicaid formularies and processes including the prior authorization processesMakes 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 issuesPerforms other tasks as assignedAchieves productivity goals with regard to calls/claims per hour as determined by the Director and Clinical Hub ManagerProvide clinical support to members of the RxAllow team regarding prior authorization concerns / submissionsConducts 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 standardsFamiliar with the claim adjudication processDevelop 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 preferredCertified Pharmacy Technician or Medical Assistant Certification desiredThird party Medical Billing experienceEMAR system knowledgeOne to three years of pharmacy experience preferredThree years of call center experience preferred Understanding of insurance and medicaid formularies and processes including the prior authorization processesFamiliar with the claim adjudication processProficiency in Microsoft Office programsPrioritize work to meet daily and competing deadlines About our Line of Business PharMerica, an affiliate of BrightSpring Health Services, 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, offering unmatched company culture, employee development, and advancement opportunities. For more information, please visit www.pharmerica.com. Follow us on Facebook, LinkedIn, and X.