Provide on-site and on-demand education for the office staff in regard to Reimbursement challenges and support services that are available. Office interaction will include:
- Benefit Investigation / Prior Authorization Process
- Support Center Services
- Medicare and Commercial coverage
- Educate on the patient communication streams
- Case management
- Billing and coding updates
- Appropriate claims submission
- Specialty Pharmacy
- Medical Benefit Interpretation
- Understanding medical necessity
- Claims / Appeal assistance
- Information related to co-pay assistance programs
- Information related to patient assistance programs
Responsible for setting up appointments and completing out bound calls to targeted offices. Assist in completing backlog casework. Additional day-to-day in-office work. Interface with physicians and manufacturer representatives to obtain and provide patient and provider specific information.
Monitor program performance for physicians and manufacturer representatives in accordance with expectations.
Research and compile provider / manufacturer representative specific information for reimbursement database.
Utilize internal resources to proactively address areas of opportunity related to the overall customer experience.
Utilize performance tracking tools & survey
- Bachelor’s Degree required; degree in Business or Healthcare related field preferred or a minimum of 8 years healthcare related reimbursement experience
- Strong medical reimbursement experience with Buy & Bill and/or Specialty Pharmacy.
- Experience in the healthcare industry including, but not limited to insurance verification, prior authorizations, and/or claim adjudication, physician’s office or clinics.
- Must have Medicare and commercial insurance coverage experience.
- Must be able to deliver and document benefit investigation outcomes and relay status reports on a regular basis.
- Ability to effectively handle multiple priorities within a changing environment.
- Strong Computer literacy
Additional Knowledge & Skills
- Previous field experience, a plus
- Account management and project management experience, a plus
- Excellent Interpersonal skills.
- Excellent written and oral communication skills
- Problem solving and decision-making skills