Medicare Part B Drug Associate

Remote Role (EST Hours)

Remote role

$20-$30 per hour

6-month Contract-to-Hire (CTH)

ABOUT THE ROLE

Our client, a leading healthcare provider, is seeking a Medicare Part B Drug Associate for a fully remote, contract-to-hire position. In this role, you will be responsible for managing, reviewing, correcting, and resubmitting Medicare Part B drug claims across both pharmacy benefit management (PBM) and medical drug billing channels. You will ensure accurate reimbursement and compliance with CMS regulations for both pharmacy-dispensed drugs (such as DME-related medications, immunosuppressants, and inhalation drugs) and provider-administered drugs (including infusions, injections, and oncology drugs) billed under the medical benefit. The ideal candidate brings expertise in both Part B drug billing pathways, strong analytical skills, and a proactive approach to reducing avoidable denials. You will collaborate closely with pharmacy managers, clinical staff, coders, and billing teams to resolve claim issues, maintain compliance, and support process improvements. This position requires working EST hours and is available for an immediate start with the potential for permanent employment.

WHAT YOU'LL DO

• Review Medicare Part B drug claims for accuracy, completeness, and compliance prior to submission across both PBM (pharmacy-billed) and medical drug (provider-billed) channels.
• Analyze Medicare remittance advice (RAs) to identify denial reasons specific to Part B drug billing—including NDC-to-HCPCS mismatches, AWP pricing issues, and documentation gaps—and determine appropriate corrective actions.
• Communicate findings and corrective actions to pharmacy managers, clinical staff, and billing teams.
• Rebill corrected claims through the appropriate Medicare channels (DDE, clearinghouse, PBM platform, or EMR) for both pharmacy-dispensed and provider-administered drugs.
• Research and resolve coding, modifier, NDC, HCPCS, and documentation issues affecting claim acceptance for both PBM and medical drug billing pathways.
• Coordinate with clinical teams, pharmacists, coders, and billing staff to obtain missing or corrected information, including drug administration records, orders, and medical necessity documentation.
• Track and follow up on outstanding Medicare Part B drug claims across both billing channels to ensure timely reimbursement.
• Maintain detailed documentation of rebill activity, denial trends, and resolution steps for PBM and medical drug claims.
• Monitor CMS updates, LCD/NCD changes, drug pricing files (ASP, AWP), and Medicare Part B drug billing guidelines to ensure ongoing compliance across both channels.
• Differentiate and apply appropriate billing rules for drugs dispensed by pharmacy under Part B vs. drugs administered by a provider under the medical benefit.
• Assist with month-end reporting, audit preparation, and process improvement initiatives for both PBM and medical drug revenue cycles.

WHAT YOU BRING

• 3-4+ years of experience in Medicare Part B billing, including both PBM (pharmacy-dispensed) and medical drug (provider-administered) billing or revenue cycle operations.
• Strong understanding of Medicare Part B drug regulations, claim formats, and common denial codes for both billing channels.
• Proficiency with billing software, clearinghouses, PBM platforms, and Medicare DDE (Direct Data Entry).
• Working knowledge of HCPCS/CPT codes, NDC codes, ICD-10, and appropriate modifier usage for Part B drugs (e.g., JW, JZ, GY, KX modifiers).
• Understanding of Part B drug pricing methodologies, including Average Sales Price (ASP), Average Wholesale Price (AWP), and drug-specific reimbursement rules.
• Ability to differentiate and apply billing rules for pharmacy-dispensed vs. provider-administered Part B drugs.
• Ability to interpret EOBs/ERAs and identify root causes of denials for drug claims (e.g., drug not covered, no prior authorization, medical necessity).
• Excellent attention to detail, problem-solving skills, and follow-through.
• Strong written and verbal communication skills.
• Experience with Epic, Inovalon, or specialty pharmacy billing platforms (preferred).
• Background in oncology, infusion, or specialty drug billing under Part B medical benefit (preferred).
• Familiarity with Medicare Advantage plans and secondary billing workflows for Part B drugs (preferred).
• Experience with PBM-specific Part B drug billing for DME-related medications, immunosuppressants, or inhalation drugs (preferred).
• Knowledge of prior authorization and coverage determination processes for Part B drugs (preferred).
• Certification such as CPC, CPB, CPMA, or equivalent (preferred).
• Specialty pharmacy or oncology billing certification (preferred).
• Deep understanding of pharmacy operations, PBM processes, and medical drug administration.
• Ability to navigate and reconcile differences between PBM and medical drug billing workflows.
• Analytical ability to identify denial root causes and implement corrective actions across multiple billing channels.