Sr. Reimbursement Specialist

Brief Summary

The primary goal of this position is to provide high quality customer service, effectively interface with patients, patient's families, national payers, home cares and medical doctor's offices to assist patient and medical provider in expediting the process starting the patient on client product, and ensure the highest level of reimbursement is attained for client product.

Specific Job Duties

• Conduct benefit investigations, verify insurance benefits for patient and physicians' offices, and submit and obtain prior authorizations as required by payer; obtain recertification for cases requiring extended treatment/coverage beyond the expiration of original approval.
• Accurately enter and maintain data as required in client database and patient files and utilize the client database to monitor outstanding items on each client case file.
• Ensure files are complete so team can determine the current status.
• Participate in conference calls as needed with Client Sales Representatives, client management and physicians' offices regarding status of cases, drug orders and status of alternative funding.
• Provide coordination of order for product, shipment of product, and therapy initiation with pharmacy and patient.
• Participate in Call Center Activities, triage and respond to incoming calls from patients, insurance companies, physicians, Sales Reps, pharmacies and homecare agencies.
• May serve as single point of contact for an assigned group of prescribers.
• Identify and report events as required by the REMS requirements for specified medication.
• Recognize adverse event, product quality complaint, potential risk events, and forward information to the appropriate team member for reporting to the manufacturer.
• Educate patients, prescribers, and others regarding program requirements, and facilitate referrals.
• Maintain good housekeeping techniques, adhering to quality and production standards and comply with all applicable company, state, and federal safety and environmental programs and procedures.

Skills and Qualifications

• High School Diploma/GED or equivalent experience
• 4 – 6 years' experience in the insurance, biotechnology, or pharmaceutical industries; customer service and/or reimbursement.
• Health Insurance claims or patient accounting experience a plus.
• Computer proficiency in MS Office applications, with database experience a plus.
• Excellent written and verbal communication skills, with demonstrated ability to communicate with others at all levels.
• Ability to manage multiple priorities and meet deadlines.
• Detail oriented with good analytical skills.
• Knowledge of third party billing, coding, medical terminology, prior authorizations and appeals preferred.