Medicare D Billing Representative
Job 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 Us
Notice of Use of Artificial Intelligence Tools in the Recruitment Process
At BrightSpring Health Services, our LEGACY culture guides how we lead, how we serve, and how we show up for one another. We are committed to doing the right thing—leading with integrity, accountability, and transparency in all that we do. As part of this commitment, we share that we may use third-party artificial intelligence (AI) to process employment data in connection with our hiring processes. Any AI tool that we use always has humans in the loop; we do not use AI to automate employment decisions or to discriminate, and we do not use zip codes as proxy. Humans – our hiring leaders and recruiter – make final decisions. BrightSpring Health Services provides reasonable accommodations to qualified applicants and employees with disabilities; if you would like to request a reasonable accommodation, please contact your recruiter or send an inquiry to TalentAcquisition@brightspringhealth.com. For more information about how our company uses AI in the hiring process, contact TalentAcquisition@brightspringhealth.com.
BrightSpring is an Equal Opportunity Employer.
BrightSpring Health Services and its affiliated companies provide equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
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