Pharmacy Billing and Med D Claims Specialist - A-Line Staffing Solutions

Pharmacy Billing and Med D Claims Specialist

A-Line Staffing is currently seeking an experienced Pharmacy Billing and Med D Claims Specialist. If you think you’re a GREAT candidate and would like to be considered for immediate consideration, call/text Day Green at +1 (469) 840-5624 or email Dgreen@alinestaffing.com.

Job Description:

The Pharmacy Billing and Med D Claims Specialist serves as a key point of contact for the Clinical Hub and is responsible for communicating with Pharmacists, Facilities, Physicians, and Prescription Drug Plans (PDPs) regarding therapeutic interchanges, prior authorization requests, and payment denials. The role ensures accurate documentation and resolution of prior authorizations, supporting the completion of required forms with clinical justifications.

Responsibilities:

• Act as a resource to facilities for obtaining information, completing necessary documentation, and following up on outstanding claims.
• Proactively communicate with facilities, physicians, and plans to resolve prior authorization issues and denials.
• Investigate claims and payment denials, providing detailed explanations to facilities.
• Initiate and complete prior authorization forms, ensuring accuracy and attention to detail.
• Provide clinical support to RxAllow team members for prior authorization concerns and submissions.
• Collaborate with EMAR systems and other stakeholders to streamline the authorization process.
• Make outgoing calls to Facilities, Plans, and Physician offices to obtain approvals.
• Communicate effectively with Client Billing Service Offices, Pharmacy Directors, and prescription drug plans to resolve customer issues.
• Achieve productivity goals such as calls/claims per hour, as determined by the Director and Clinical Hub Manager.
• Adhere to Company’s Code of Business Conduct, policies, and applicable federal and state laws.
• Develop expertise in claim adjudication, insurance verification, and back-end billing workflows.
• Prioritize work to meet daily and competing deadlines.
• Perform other tasks as assigned.

Competencies:

• Interpersonal Skills: Maintains confidentiality, resolves conflicts constructively, and remains open to feedback.
• Communication Skills: Writes and speaks clearly, listens actively, and presents information effectively.
• Teamwork: Contributes to team success, fosters a positive environment, and supports group objectives.
• Professionalism: Handles pressure tactfully, upholds ethical standards, and accepts responsibility.
• Organizational Skills: Plans effectively, prioritizes efficiently, and develops actionable goals.
• Adaptability: Adjusts to changes, manages competing demands, and remains flexible in dynamic environments.
• Initiative: Proactively seeks growth opportunities and takes independent action when necessary.

Position Qualifications:

Education:

• Required: High School Diploma or Associate Degree.
• Desired: Certified Pharmacy Technician (CPhT) or Medical Assistant Certification.
• Desired: Bachelor’s Degree.

Experience:

• Required: Third-party medical billing experience.
• Required: EMAR system knowledge.
• Desired: 1-3 years of pharmacy experience.
• Desired: 3 years of call center experience.

Skills:

• Certified Pharmacy Technician.
• Data Entry skills (40 WPM).
• Research ability and Insurance experience.
• Proficiency in Microsoft Excel.
• Experience with Frameworks and LTC400 (preferred).

Technical Skills:

• Proficiency in Microsoft Office programs.

Job Schedule & Location:

• Monday - Friday, 9:00 am - 5:30 pm
• Location: Arlington TX 76010 United States

Job Salary/Wage:

• $19.00 per hour

If you think you’re a GREAT candidate and would like to be considered for immediate consideration, call/text Day Green at +1 (469) 840-5624 or email at Dgreen@alinestaffing.com.