Reimbursement Specialist

Job Description THE POSITION

The Reimbursement Specialist primarily responsible is to interface with Patients, HCPs and Payers by providing reimbursement support for activities related to benefit coverage, prior authorization, claim denials, appeals, triage to third party support centers and general inquiry.

Our employees are tasked with delivering excellent business results through the efforts of their teams. These results are achieved by:

• Provide dedicated and personalized support delivered over the phone, CRM, and email.
• Complete investigations and answer questions regarding insurance benefits, including information about coverage and out-of-pocket costs.
• Assist with prior authorization and medical necessity processes, benefit verification and assistance in a manner that is consistent with industry best practice.
• Determine when call reason is best handled by third party support center and triage accordingly.
• Maintain positive attitude and a helpful approach to customers and clients.
• Conduct enrollment intake for all incoming inquiries.
• Participate in continuous quality improvements and training opportunities.
• All other duties as assigned.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.

• Assist callers with benefit verifications and providing support related to coverage, out-of-pocket costs and prior authorizations as needed.
• Triage to appropriate third party support centers.
• Focus on results in a professional, ethical, and responsible manner when dealing with patients, caregivers, customers, vendors, team members, and others.
• Accepts being accountable and responsible in work practices and expectations. Delivers what is promised.
• Fosters a collaborative, team‑oriented attitude. Communicates effectively with others with clarity and transparency.
• Uses innovative critical and creative thinking to evaluate and solve work and customer issues.
• Seeks assistance in solving work problems through collaboration and information seeking.
• Learn, understand and follow all company and client policies and procedures.
• Excellent attendance.
• Must be able to work rotating 8‑hour shifts Monday through Friday.

The above list reflects the general details necessary to describe the expectations of the position and shall not be construed as the only expectations that may be assigned for the position.

An individual in this position must be able to successfully perform the expectations listed above.

• Strong pharmacy reimbursement experience, especially understanding of prior authorization process.
• Experience conducting benefit verifications with payers, preferably supporting retail prescription drug products.
• Knowledge of healthcare administration and specifically healthcare billing and reimbursement procedures and regulations.
• Knowledge of Retail Pharmacy Operations preferred.
• Excellent oral, written, and interpersonal communication skills.
• Ability to multi‑task.
• Positive attitude.
• Accurate and detail‑oriented.
• Ability to work independently and function as a team player.
• Ability to work in a fast paced, metric driven environment, while remaining patient minded.
• Strong computer skills with a working knowledge of Microsoft Word, Excel, and PowerPoint.

• Customer service and/or contact center experience.
• Reimbursement/Patient Services experience.

The physical and mental requirements along with the work environment characteristics described here are representative of those an individual encounters while performing the essential functions of this position.

Office:
While performing the essential functions of this job the employee is frequently required to reach, grasp, stand and/or sit for long periods of time (up to 90% of the shift), walk, talk and hear; occasionally required to lift and/or move up to 25 pounds. The noise level in the work environment is usually moderately quiet, with frequent interruptions and multiple demands.

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