Medicare B Specialist

About the role

The Medicare B Specialist will be responsible for research, billing, collections, and/or resolution of an assigned account portfolio in accordance with PharMerica’s policies. 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.

Responsibilities

• Conducts job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct and Ethics, policies and procedures, Corporate Compliance Agreement, applicable federal and state laws, and professional standards
• Investigates Medicare B eligibility such as diagnosis, place of service, and medication for payment
• Prepares assignment of benefits, written orders, and obtains signatures from responsible parties
• Collections refill requests and dated manifest for each dispense
• Transmits electronic claim to Medicare B and after primary payment is received, prepares claim for secondary payer when applicable
• Responds to Medicare payer audits
• Maintains a thorough knowledge of Medicare coverage criteria, billing, coding, and documentation requirements

Qualifications

• High School Diploma or GED; Associate degree desired
• Two years billing and/or collections experience; Medicare B preferred
• Familiarity with standard concepts, practices, and procedures with discipline
• Certified Pharmacy Technician
• Strong analytical, communication, and interpersonal skills

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.