Reimbursement Specialist

About the role

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.

Responsibilities

• 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.
• Aid in prior authorization and medical necessity processes, benefit verification, and assist 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 a 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.

Qualifications

• 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.