Reimbursement Specialist

Works in a fast paced, high-volume contact center environment to provide product specific reimbursement support to patients, healthcare providers, patient advocates, and manufacturer representatives. Will frequently interact via telephone with commercial payers to conduct insurance verifications and benefit investigations. Works daily with commercial payers to ensure appropriate coverage and reimbursement in a variety of therapeutic areas.  Must have a solid working knowledge of insurance plans and benefit structures in order to obtain detailed benefit information and maximize plan benefits.  Obtains payer specific prior authorization procedures and documentation requirements, if applicable, and facilitates the prior authorization process for patients and healthcare providers.  A general understanding of Medicare and Medicaid programs is desired.  Position may require sales, project management and/or account coordination skills depending on the specific program.

Location: Hybrid role in Cary, NC. Onsite requirement of 2 days a week.

Compensation: The target budget for this role is between $23 and $24 an hour.

Key Responsibilities

• Contact payers to verify patient eligibility and product specific coverage information.

• Interface with physicians, advocates, patients, and manufacturer representatives to obtain and provide drug specific coverage information.

• Provide prior authorization assistance as well as claims assistance, including billing and coding instructions, to physicians and/or office staff.

• Provide accurate and timely follow-up to all reimbursement inquires in accordance with program guidelines.

• Ensure that the intake information is accurate and complete in order to perform all reimbursement research.

• Research and compile payer specific information for reimbursement database.

• Utilize internal resources to identify and provide alternate funding sources for patients without insurance or adequate coverage through their insurer.

Minimum Requirement

Typically requires 3+ years of related experience.

Education
HS Diploma or equivalent

Critical Skills

• 2+ year's experience within a healthcare environment.

• Medical claims experience.

• Experience in the healthcare industry including, but not limited to, insurance verification and/or claim adjudication, physician’s office or outpatient billing, pharmacy and/or pharmaceutical manufacturers.

• Must be able to compose and document benefit investigation outcomes and prepare written status reports to management on a regular basis.

Additional Knowledge & Skills

• ICD-10, HCPCS and CPT experience

• Ability to effectively handle multiple priorities within a changing environment

• Interpersonal skills

• Strong written and oral communication skills

• Strong organizational skills

• Proficient in MS Office

• Problem solving and decision-making skills