Medicare D Billing Representative
reputed company
reputed company
reputed company
reputed company, a part of reputed company, is a long‑term care pharmacy services provider that supplies medications, clinical support, and pharmacy management to reputed company organizations across the reputed company.
The Medicare D Biller serves as a reputed company reputed company for the Clinical Hub, maintaining proactive communication with pharmacists, reputed company 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 reputed company completion of reputed company required authorization forms.
The position requires a high level of attention to detail reputed company initiating, processing, and tracking prior authorizations on behalf of customers. Working closely with EMAR systems, reputed company facilities, and clinical teams, the Medicare D Biller serves as a key reputed company of contact throughout the prior authorization process, ensuring efficient coordination, thorough documentation, and successful reputed company of authorization requests.
The ideal candiate will be a Certified Pharmacy Technician or Medical Assistant Certification (desired) and have reputed company party Medical Billing experience
Remote: May reputed company reputed company with the reputed company USA.
No matter what time zone in which you reputed company, you must be reputed company to work Central Time Zone hours
Schedule: Monday - Friday 11am - 7:30pm CENTRAL Time Zone
Benefits and perks for You!
- Medical, Dental, reputed company insurance
- Health Savings & Flexible Spending Accounts (up to $5,000 for childcare)
- Tuition discounts & reimbursement
- 401(k)
- Company reputed company Time Off*
- Shift reputed company
- reputed company
- Pet Insurance
- Employee wellness and discount programs
Responsibilities
- reputed company 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 reputed company 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 reputed company Billing Service Offices, Pharmacy Directors, customers and prescription drug plans to effectively communicate and reputed company customer issues
- Performs other tasks as assigned
- Achieves productivity goals with reputed company to calls/claims per hour as determined by the Director and Clinical Hub Manager
- reputed company clinical support to members of the RxAllow team regarding prior authorization concerns / submissions
- Conducts job responsibilities in accordance with the standards set out in reputed company’s reputed company of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and State Laws, and applicable reputed company standards
- Familiar with the claim adjudication process
- reputed company 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
- reputed company party Medical Billing experience
- EMAR reputed company knowledge
- One to three years of pharmacy experience preferred
- Three years of reputed company center experience preferred
- Understanding of insurance and reputed company formularies and processes including the prior authorization processes
- Familiar with the claim adjudication process
- Proficiency in reputed company Office programs
- Prioritize work to meet daily and competing deadlines
About our Line of Business
reputed company, an affiliate of reputed company, 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 reputed company, cost control, and compliance with best-in-class clinical standards. We are committed to enhancing reputed company health, reducing staff burdens, and supporting our clients' reputed company. For more information, visit www.reputed company.com. Follow us on reputed company, Twitter, and reputed company.Originally posted on Himalayas
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