TEMP- Reimbursement Specialist Location: Brisbane, CA Company Order Number: 2688 # of openings: 1
Description
* Required qualifications and experience Minimum of three years experience in healthcare reimbursement Proficient in all aspects of reimbursement (i.e., benefit investigations, payor reimbursement policies, regulatory, and administrative rules). Pharmacy delivery knowledge is recommended, not required. Great telephone ability and comfort in handling outgoing and incoming calls Able to plan, prioritize and manage multiple tasks Social work and Patient Relations experience a positive Excellent customer service ability Enjoys working in a team environment Dependable and accountable in assigned tasks This position requires some flexibility in work shift Understands reimbursement and funding resources and how to successfully access these resources Knowledge of managed care industry including government payors Excellent investigational and analytical skills with a proven ability to communicate effectively in both written and verbal format Demonstrates effective problem solving and excellent customer service Exceptional attention to detail and ability to prioritize tasks RESPONSIBILITIES The PAH Pathways Reimbursement Counselor acts as a liaison between patients, providers, MDs, distributors and insurance carriers to assure services are provided in the least restrictive, least costly manner. Provides customer-focused reimbursement support to patients, distributors, physicians and internal sales force. Coordinates initiation of therapy with distributor Educates, informs, and assists patients and providers to navigate through the reimbursement process Identifies barriers to reimbursement and continually identifies and recommends program efficiencies to Team Supervisor Identifies and facilitates referrals to alternative coverage options and financial assistance programs for patients who are under insured or require copy assistance Establishes relationships with appropriate stakeholders and third party partners Able to investigate patient’s insurance benefits Identifies network providers, provider restrictions, copays as needed Documents requirements for prior authorization and medical review process Documents activities appropriately in progress notes Pursue product coverage for patients in accordance with the payers’ authorization requirements within the department’s established performance criteria Consults with team members on an as needed basis
