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Med D Billing Representative

PharMerica Corporation is a premier institutional pharmacy services provider, dedicated to providing quality patient care and innovative pharmacy solutions to institutional customers and patients in long-term care settings. With nearly $2 billion in annual revenues, PharMerica is one of the nation's largest institutional pharmacy companies. PharMerica operates more than 100 institutional pharmacies in 45 states and serves nursing facilities that care for approximately 350,000 patients.

 

 

Summary

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.  They are responsible for investigating and calling the plans to determine the reasons for payment denials, the Physicians, and Facilities to provide the reasons for denial, while updating and documenting prior authorizations with clinical justifications, under the supervision of a registered Pharmacist.      

 

Essential Functions:

•             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.

•             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.

•             To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill, and/or ability required.  Each essential function is required, although reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

Position Qualifications

•             Education/Learning Experience

             Required:  HS Diploma or equivalent experience

             Desired:  Associate’s 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:  Pharmacy Tech training or related experience. Able to become certified.

               Desired: Certified Pharmacy Technician

•             Behavior Competencies

             Required:  Interpersonal Skills, Oral Communication, Written Communication, Teamwork, Ethics, Organizational Support, Judgment, Planning/Organizing,  Professionalism, Adaptability, Initiative,

 

EOE M/F/D/V

 

Accelerate Your Career with PharMerica!

Company
PharMerica
Posted
08/19/2018
Type
Full time
Location
Arlington, TX 76001, US