Medicare D Billing Representative

About the role

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.

Responsibilities

• Act as a resource to the facilities in obtaining information, completing necessary documentation, or following up on outstanding claims.
• 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.
• Provides 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.
• Develops a strong understanding of the insurance verification, adjudication, back-end billing process and becomes a subject matter expert on the insurance queues and billing workflow.

Qualifications

• A 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.
• Familiarity with the claim adjudication process.
• Proficiency in Microsoft Office programs.
• Prioritize work to meet daily and competing deadlines.

Benefits and Perks

• 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.