Reimbursement Specialist

POSITION SUMMARY/RESPONSIBILITIES

Identifies and enrolls indigent and under-insured patients into drug assistance reimbursement programs which provide drug replacement and reimbursement compensation. Monitors contain eligibility status and document drug shipments received through a computerized tracking system. Serves as a resource in facilitating resolution of insurance denial referrals. Communicates effectively with pharmacy, hospital administration, medical staff, patients and personnel in the patient assistance programs using verbal and written interpersonal communication skills.

Requires the ability to work independently and coordinate assigned projects efficiently. Effectively utilizes problem-solving ability, significant interpersonal contact and concentration abilities, analytical skills and in-depth knowledge of computer software. Coordinates all information regarding patients enrolled in assistance programs for drug therapies using various computer software programs. Creates, expands and maintains computerized databases to support patient enrollment in assistance programs and tracks case-specific assistance provided in response to reimbursement denials.

Conducts patient interviews and conveys reimbursement denial potential to patients and medical staff. Reviews all outpatient 3rd party rejections and assists the patient in resolving the problem. Coordinates 3rd party billing, problems with eligibility, rejections, etc. with the Outpatient Pharmacy Supervisor and the Pharmacy Billing Section.

EDUCATION/EXPERIENCE

Texas State Board of Pharmacy registration required. National Certification as a Certified Pharmacy Technician (CPhT) is recommended. Three (3) years' experience in a medical or pharmacology-related field to include project coordination; database/spreadsheet development and management; and/or application programming; processing and overseeing medical insurance billing and reimbursement cost capture is preferred. Must have demonstrated independent judgment