Our Cary NC client is seeking an experienced Reimbursement Specialist. This position requires the availability Monday - Friday between 8am to 8pm. This is a very fast paced and high volume call center environment that provides program specific access and reimbursement support to patients, healthcare providers, and manufacturer representatives.
- Will frequently interact via telephone with commercial payers to conduct benefits verification.
- Works daily with commercial payers to ensure appropriate coverage and reimbursement in a variety of therapeutic areas.
- Must have a solid working knowledge of insurance plans and benefit structures in order to obtain detailed benefit information and maximize plan benefits.
- Obtains payer specific prior authorization procedures and documentation requirements and share overall benefits verification results with healthcare providers and patients.
- A general understanding of Medicare and Medicaid programs is desired.
- Contact payers to verify patient eligibility and product specific coverage information.
- Assist patients and physicians with prior authorization,appeal management, nurse training and home health administration.
- Interface with physicians, patients, and manufacturer representatives to obtain and provide drug specific coverage information.
- Provide support and screening for patient assistance program and co-pay offerings.
- Conduct research to identify appropriate alternate funding sources and make recommendation
- Provide accurate and timely follow-up to all reimbursement inquires in accordance with program guidelines.
- Ensure that the intake information is entered accurately and completely in order to perform all reimbursement research.
- Research and compile payer specific information for reimbursement database.
- Complete end to end processing of new referrals and re-enrollments
- Follow program cadence for outreach to patients and health care providers to ensure patient can start therapy on time.
- Complete healthcare provider's credentialing for online portal access to HCP and office staff.
- High School diploma or equivalent
- 5+ years of customer service experience within a healthcare environment.
- 5+ years of Medical Claims or insurance experience.
- Experience in the healthcare industry including, but not limited to, insurance verification and/or claim adjudication, physician’s office or out patient billing, pharmacy and/or pharmaceutical manufacturers.
- Must be able to compose and document benefit investigation outcomes and prepare written status reports to management on a regular basis.
- Ability to work on multiple systems and take ownership of patient cases to ensure timely completion of all required steps in the process.
- CPR+ system knowledge preferred.
- ICD-10 and HCPCS experience is preferred
- Ability to effectively handle multiple priorities within a changing environment
- Strong verbal and written communication skills in order to effective communicate with co-workers, insurance carriers, patients, and medical office personnel.
- Strong organizational skills
- Proficient is MS Office
- Problem solving and decision-making skills