Medicare D Billing Representative

BrightSpring Health Services; Louisville (KY); Sur place; USD 35 000 - 55 000; Plein temps

Avantages offerts par ce poste

Medical Insurance

Dental Insurance

Vision Insurance

Health Savings Account

Flexible Spending Accounts

Tuition discounts

401(k)

Paid Time Off

Shift Differential

DailyPay

Pet Insurance

Wellness programs

Résumé du poste

PharMerica, part of BrightSpring Health Services, seeks a Medicare D Billing Representative. The role involves acting as liaison for the Clinical Hub, addressing prior authorizations, and researching denials with plans, facilities, and PDPs.

Remote work within the Continental USA is allowed with Central Time Zone hours. Qualifications include a High School Diploma (associates or bachelor’s preferred), plus experience in third-party medical billing and EMAR systems.

Qualifications

• High school diploma or higher; associates or bachelor’s preferred.
• Certified Pharmacy Technician or Medical Assistant designation is desirable.
• Experience with third-party medical billing and insurance processes.

Responsabilités

• Serve as primary liaison for the Clinical Hub and facilities.
• Research denials by contacting plans and coordinate with facilities.
• Update and document prior authorizations with clinical justifications.
• Maintain timely completion of required authorization forms.
• Communicate with pharmacists, PDPs, and physicians as needed.
• Work with EMAR systems and billing workflows to resolve issues.

Connaissances

Attention to detail

EMAR system knowledge

Call center experience

Insurance knowledge

Medicaid formularies

Prior authorizations

Microsoft Office

Formation

High School Diploma

Associates degree

Bachelor's degree preferred

Outils

EMAR

Microsoft Office

Description du poste

Medicare D Billing Representative

Job Locations: US-KY-LOUISVILLE

ID: 2026-193672

Line of Business: PharMerica

Position Type: Full-Time

Overview

PharMerica, a part of Brightspring Health Services, is a longterm 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 knowledgeOne 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 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. For more information, visit www.pharmerica.com. Follow us on Facebook, Twitter, and LinkedIn.