Remote opportunity at
BrightSpring Health ServicesMedicare D Billing Representative
PharMerica, operating as part of BrightSpring Health Services, is looking for a Medicare D Billing Representative to join its team on a remote basis. This position…
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About This Role
PharMerica, operating as part of BrightSpring Health Services, is looking for a Medicare D Billing Representative to join its team on a remote basis. This position requires the employee to reside within the Continental United States and work from 11:00 AM to 7:30 PM Central Time, Monday through Friday. The person in this role will act as a primary communication link for the Clinical Hub, working alongside pharmacists, physicians, healthcare…
Job Description
PharMerica, operating as part of BrightSpring Health Services, is looking for a Medicare D Billing Representative to join its team on a remote basis. This position requires the employee to reside within the Continental United States and work from 11:00 AM to 7:30 PM Central Time, Monday through Friday. The person in this role will act as a primary communication link for the Clinical Hub, working alongside pharmacists, physicians, healthcare facilities, and Prescription Drug Plans to manage therapeutic interchange opportunities and prior authorization requests.
The Medicare D Billing Representative is tasked with investigating payment denials, communicating with insurance providers to identify denial reasons, and coordinating with facilities to gather necessary documentation. Key duties involve updating prior authorizations with clinical justifications, ensuring accurate completion of authorization forms, and utilizing EMAR systems. Candidates should be capable of meeting productivity targets related to calls and claims per hour, supporting the RxAllow team, and demonstrating a strong understanding of insurance verification, claim adjudication, and back-end billing procedures.
Responsibilities
- Serve as a resource for facilities to gather information, complete documentation, and follow up on pending claims
- Place outgoing calls to medical facilities, insurance plans, and physician offices to secure approvals
- Collaborate with Client Billing Service Offices, Pharmacy Directors, customers, and prescription drug plans to resolve issues
- Meet productivity standards regarding hourly call and claim volumes established by leadership
- Offer clinical support to the RxAllow team concerning prior authorization submissions and concerns
- Perform job duties in alignment with company policies, the corporate compliance agreement, ethical standards, and relevant laws
Requirements
- Reside within the Continental United States
- Work Central Time Zone hours from Monday through Friday, 11:00 AM to 7:30 PM
- Possess experience in third-party medical billing
- Understand insurance and Medicaid formularies, processes, and prior authorization workflows
- Familiarity with claim adjudication and EMAR systems
- Proficiency in Microsoft Office applications
Qualifications
- High school diploma or Associate degree
- Bachelor's degree preferred
- Certified Pharmacy Technician or Medical Assistant certification desired
- One to three years of pharmacy experience preferred
- Three years of call center experience preferred
Core Skills
Benefits
- Medical, dental, and vision insurance
- Health Savings and Flexible Spending Accounts with up to $5,000 for childcare
- Tuition discounts and reimbursement
- 401(k) plan
- Company-paid time off
- Shift differential
- DailyPay
- Pet insurance
- Employee wellness and discount programs
Frequently Asked Questions
Answers are based only on the employer’s listing; where it doesn’t say, neither do we.
Is this position remote?
Yes, this role is remote and can be based anywhere within the Continental United States. However, you must work Monday through Friday from 11:00 AM to 7:30 PM Central Time regardless of your time zone.
What are the core duties of the Medicare D Billing Representative?
The role involves communicating with healthcare facilities, physicians, and insurance plans regarding prior authorizations and therapeutic interchange opportunities, researching payment denials, and tracking authorizations through EMAR systems.
What education or certifications are preferred for applicants?
A Bachelor's degree is preferred over a high school diploma or Associate degree. A Certified Pharmacy Technician or Medical Assistant certification is also desired, along with one to three years of pharmacy experience and three years of call center experience.
What is the salary for this job?
The job posting does not specify a salary.
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