Reimbursement Analyst

Description

At Gifthealth, we're revolutionizing the way people experience healthcare by simplifying the process of managing prescriptions and health services. Our mission is to provide a seamless, personalized, and efficient healthcare experience for all our customers. We're a dynamic, innovative, and customer-centric company dedicated to making a positive impact on people's lives.

At Gifthealth, we're revolutionizing the way people experience healthcare by simplifying the process of managing prescriptions and health services. Our mission is to provide a seamless, personalized, and efficient healthcare experience for all our customers. We're a dynamic, innovative, and customer-centric company dedicated to making a positive impact on people's lives.

A Reimbursement Analyst is responsible for being the primary point of contact in assisting patients or healthcare providers in obtaining access to therapy for the reimbursement hub program to which they are assigned. Primary activities may include researching and analyzing moderate to complex reimbursement policies, billing, benefit investigations, prior authorization, appeals and patient assistance support programs. Responsibilities may include interactions with client contacts as well as handling of escalated cases/issues.

• Assist patients and healthcare providers with moderate to complex billing and coding, insurance benefit investigations, prior authorization, appeals and patient assistance support programs inquiries.
• May include acting as regional contact for senior level client contacts.
• Manage patient cases and interact with external contacts like payers and other stakeholders.
• Assist with coordination of relevant tasks/activities between Gifthealth and the client.
• Review and resolve denied or underpaid insurance claims.
• Identify and assess patient specific insurance coverage options for client specific products.
• Reverify patient benefits at predetermined time frames.
• Document all activities in program database within required timelines.
• Research payer medical policy.
• Monitor and update payer prior authorization requirements and coverage policies for specified client program.
• Prepare and/or assist with preparation of reports as requested, including adverse event and product complaint reports.
• Review and process documentation to determine patient specific eligibility for client patient support program(s), as appropriate.
• Complete quality monitoring and quality assurance activities, as assigned.
• Travel to and attend client meetings, off-site training, and/or conferences. Travel time estimate: 5%.

• Minimum four years recent healthcare experience (2 years’ direct industry preferred).
• Exhibit proficiency in Microsoft Office products.
• Excellent customer service skills (call center experience preferred).
• Advanced problem solving, research and analytical skills.
• Advanced communication skills, both written and verbal.
• Attention to detail, data entry accuracy required.
• Ability to multi-task and manage time independently.
• Client interaction experience preferred.
• Advanced knowledge of medical insurance (public and commercial), billing and coding and associated terminology.

• Location:
  
  Remote
• Schedule:
  
  Full-time
• May require availability or flexibility for escalations.
• Regular meetings with teams, departments, or leadership to ensure alignment.

• Ability to sit for extended periods of time while working at a computer and on the phone throughout the workday.
• Ability to engage in continuous phone and computer use, including navigating multiple systems simultaneously, for the duration of the shift.
• Ability to perform repetitive motions for an entire shift, including typing, mouse use, and phone handling.
• Ability to view and read information on a computer screen for prolonged periods.
• Ability to communicate clearly and professionally via phone, email, and internal systems.
• Ability to manage a high volume of inbound and outbound calls while maintaining attention to detail and accuracy.
• Ability to work in a remote environment with minimal distractions and maintain productivity and performance standards.
• Ab…