PharMerica Corporation is a premier institutional pharmacy services provider, dedicated to providing quality patient care and innovative pharmacy solutions to institutional customers and patients in long-term care settings. With nearly $2 billion in annual revenues, PharMerica is one of the nation's largest institutional pharmacy companies. PharMerica operates more than 100 institutional pharmacies in 45 states and serves nursing facilities that care for approximately 350,000 patients.
Place calls to facilities, physicians, and/or PDP regarding clinical intervention claims.
Act as a resource to the facilities in obtaining information completing necessary documentation or following up on outstanding claims. Follows a schedule of daily calls.
Research and Documents details of all outbound calls.
Works with Client Service Offices, Pharmacy Directors, Facilities, and Prescription Drug Plans by effectively communicating and resolving customer issues.
Understands Insurance and Medicaid Formularies.
Understands Medicaid Prior Authorization Process.
Develop a strong understanding of insurance verification, adjudication, back-end billing process to become a subject- matter expert on insurance queues and billing workflow.
Ensures that adjudication and billing functions are being performed accurately and in compliance with established policies and procedures, defined by the company.
Participates in basic and update training as required and satisfactorily completes certification requirements.
Provides information and assistance to Physicians and/or Nursing Facilities, regarding Medicare prescription drug coverage.
Utilize internet based programs to assist clients with prescription drug plan options.
Serves as liaison between the long term care facility and the patient's insurance or Medicaid provider to assure financial compensation for medications.
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.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill, and/or ability required. Each essential function is required, although reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Required: High School Diploma or equivalent
Desired: Some College, Associates Degree
Required: 1- 3 Years call center Experience
Desired: Experience in Healthcare Environment
Accelerate Your Career with PharMerica!
Nearest Major Market: Arlington Texas
Nearest Secondary Market: Dallas