Medical D Biller

  • Job ID:

  • Pay rate range:

    $14 - $17
  • City:

  • State:

  • Duration:

    12/02/2019 - 06/02/2020
  • Job Type:

  • Job Description

    One of the world's largest and fastest-growing pharmaceutical companies with $2 Billion in annual revenue is seeking a     Medicaid D Biller


    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.      


    Major Responsibilities:

    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.
    • 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.

    Position Qualifications

    • Education/Learning Experience

    • Required: High School Diploma, Associates  Degree
    • Required: Certified Pharmacy Technician
    • Desired:   Bachelor’s Degree
    • Work Experience
    • Required:    Third Party Medical Billing Experience

    • Desired:    1-3 Years  Pharmacy Experience
    • Desired:    3 Years Call Center Experience

    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.

    Physical Requirements/Demands of the position:

    Standing, Sitting,Walking & Lifting



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