The Role
We’re looking for a Reimbursement Specialist, to join our team. The position would be an advocate for our patient and work as part of interconnected team whose goal is assisting patients and those involved in their care with reimbursement challenges. Pay is negotiable based on experience and skill set.
What You’ll (Primarily) Do:
- Communicate insurance benefits to patients
- Contact insurance companies to verify patient benefits and eligibility
- Work directly with providers throughout the reimbursement process
- Obtain all insurance authorizations and referrals
- Appeal denials of authorizations, referrals & GAP exceptions as needed
- Work with pharmaceutical vendors to stay familiar with saving programs available to patients
- Contact insurance pre-certification department for approval of medications
- Work directly with insurance companies on resolving authorization issues on denied claims
- Maintain timely and accurate documentation in Pioneer and GSuite regarding pre-authorization/pre-certification activity related to each case
- Accurately delegate proper ICD-10 codes to ensure payments and approvals
- Other duties and responsibilities as needed
What We’re Looking For:
- Someone with excellent organizational skills with attention to detail and an ability to manage multiple tasks simultaneously while maintaining a high level of quality
- Excellent communication and interpersonal skills, particularly through telephone communication, written communications and an ability to build strong patient rapport.
- Ability to operate a computer & basic office equipment, including knowledge of Microsoft office and GSuite products
- A minimum of 2 years' experience working in a medical office or pharmacy is highly preferred.
- Knowledge of PBM’s and the managed care environment.
- Knowledge of Diagnosis coding
- Ability to work under pressure and with constant interruptions