Medical D Biller

  • Job ID:

  • Pay rate range:

    $26 - $27
  • City:

  • State:

  • Duration:

    08/05/2019 - 02/05/2020
  • Job Type:

  • Job Description

    Two Medical D Clinical Hub Nurses two 6-month contract assignments located in Arlington, TX. 

    Job description and requirements for the two Medical D Niurses needed: 

    To provide high level of attention to detail while initiating and completing the Prior Authorization forms for our customers. Working with EMAR systems, as well as, facilities and serving as key contact for the completion of Prior Authorizations.

    • Receives and verifies patient Insurance information for accuracy and completion
    • Good understanding of Commercial Insurance and benefit verification
    • Extensive knowledge of  Med D and Medicaid coverage benefits
    • Ability to research payer benefits and deliver favorable outcomes
    • Working knowledge of drug reimbursement procedures (i.e. Benefit Investigations, Prior Authorizations and letters of medical necessity)
    • Excellent understanding of  EMAR systems
    • Ability to express ideas clearly, both in written and verbal communication
    • Strong attention to detail, a self- starter and the ability to multitask
    • Adaptable to changing priorities as needed
    • Ability to collaborate with the Physicians, Director of Nursing and the facility staff to ensure Pharmacy program objectives are met

    • Performs other tasks as assigned.

    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.

    • LVN or RN
    • Associates or Bachelor’s Degree
    • 2+ years clinical experience in LTC, and knowledge of EMARS.
    • 2+ years in  insurance or billing


    To perform the job successfully, an individual should demonstrate the following competencies :

    Interpersonal Skills - Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others' ideas and tries new things.

    Oral Communication - Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings.

    Written Communication - Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.

    Teamwork - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed.

    Ethics - Treats people with respect; Keeps commitments; Inspires the trust of others; Works with integrity and ethically; Upholds organizational values.

    Organizational Support - Follows policies and procedures; Completes administrative tasks correctly and on time;  Supports organization's goals and values; Benefits organization through outside activities.

    Judgment - Displays willingness to make decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in decision-making process; Makes timely decisions.

    Planning/Organizing - Prioritizes and plans work activities; Uses time efficiently; Plans for additional resources; Sets goals and objectives; Organizes or schedules other people and their tasks; Develops realistic action plans.

    Professionalism - Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.

    Adaptability - Adapts to changes in the work environment; Manages competing demands; Changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events.

    Initiative - Volunteers readily; Undertakes self-development activities; Seeks increased responsibilities; Takes independent actions and calculated risks; Looks for and takes advantage of opportunities; Asks for and offers help when needed.

    #PCO, #Pharma




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