Medical D Biller

  • Job ID:

  • Pay rate range:

    $16 - $17
  • City:

  • State:

  • Duration:

    08/12/2019 - 02/12/2020
  • Job Type:

  • Job Description

    *** 8 new Medical D Billing Representatives needed for our client located in Arlington, Texas for six month contract assignments. 

    Job description and requirements for 8 new Medical D Billing Representatives:

    Serves as a key point of contact for the Clinical Hub and proactively communicates with Pharmacists, Facilities, Physicians and PDP’s regarding Therapeutic Interchanges, and prior authorization requests.  They are responsible for investigating and calling the plans to determine the reasons for payment denials, the Physicians, and Facilities to provide the reasons for denial, while updating and documenting prior authorizations with clinical justifications, under the supervision of a registered Pharmacist.      

    Essential Functions:

    • Act as a resource to the facilities in obtaining information completing necessary documentation or following up on outstanding claims.
    • Certified Pharmacy Technician 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.
    • Work closely with peers and management.
    • Performs other tasks as assigned.
    • Maintain a clean and organized work area.
    • 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
    • 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.
    • Prioritize work to meet daily and competing deadlines.
    • Proficiency in Microsoft Office.
    • High School Diploma
    • Associates  Degree
    • Certified Pharmacy Technician
    • Third Party Medical Billing Experience
    • 1-3 Years  Pharmacy Experience
    • 3 Years Call Center Experience

    #PCO, #Pharma

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