PBM Biller I
IV League is one of Southern California's most recognized home infusion companies. We work with prominent hospitals, physicians, oncology clinics, M.S. clinics, and surgery centers, providing I.V. and specialty medications for patients in the home or office settings. We currently have a full-time PBM Biller I position open in our Culver City office. Pharmacy Technician candidates with pharmacy retail experience are strongly encouraged to apply. REMOTE WORK IS NOT AVAILABLE FOR THIS POSITION.
Position Summary:
The PBM Biller is responsible for processing and managing pharmacy claims submitted to Pharmacy Benefit Managers (PBMs). This position ensures accurate and timely billing, resolves claim rejections, and works closely with internal departments and external PBMs to ensure proper reimbursement for prescription medications and services.
Key Responsibilities:
- Submit pharmacy claims and prior authorization requests to PBMs using billing software.
- Review and correct rejected or denied claims to ensure timely resubmission.
- Initiate, track, and follow up on prior authorizations with payers and prescribers to ensure timely approvals.
- Verify patient insurance and prescription benefit coverage details.
- Coordinate with pharmacies, insurance carriers, and PBMs to resolve billing discrepancies.
- Maintain up-to-date knowledge of PBM rules, formularies, and reimbursement policies.
- Ensure accuracy of billing codes, including NDC and HCPCS codes as applicable.
- Follow up on unpaid or underpaid claims to secure appropriate payment.
- Maintain patient confidentiality and comply with HIPAA and other healthcare regulations.
- Document all billing activity in electronic systems.
- Assist in audits, reporting, and compliance reviews as required.
Qualifications:
- High school diploma or GED required.
Experience:
- A minimum 2 years of Pharmacy Technician experience is required.
- Minimum of 1 year of Authorization experience is preferred.
Skills:
- Strong attention to detail and organizational skills.
- Excellent communication and problem-solving skills.
- Ability to interpret insurance benefits and EOBs.
Preferred Qualifications:
- 1–3 years of pharmacy billing, prior authorization, or PBM experience preferred.
- Certified Pharmacy Technician (CPhT) is a plus.
- Knowledge of Medicare Part D and commercial PBM plans.
- Familiarity with PBM processes, pharmacy claim systems, and third-party payer requirements.
- Familiarity with medications and NDC’s preferred.
- Experience with PBM software, Visual Script or PrimeRX preferred.
Physical Requirements:
- Possible prolonged periods sitting at a desk and working on a computer.
- Must be able to lift up to 10 pounds at times.
Work Schedule:
- Monday – Friday 9 AM - 6 PM or 9:30 AM - 6:30 PM
Reports to:
- Director of Revenue, PBM/Auth Manager
(Waiting period may apply for benefits)
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.
Job Type: Full-time
Pay: $22.00 - $26.00 per hour
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Flexible spending account
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Retirement plan
- Vision insurance
Ability to Commute:
- Culver City, CA 90230 (Required)
Ability to Relocate:
- Culver City, CA 90230: Relocate before starting work (Required)
Work Location: In person
