Reimbursement Specialist

Job Description THE POSITION: 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. ESSENTIAL DUTIES AND RESPONSIBILITIES: Our employees are tasked with delivering excellent business results through the efforts of their teams. These results are achieved by: 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. Assist with prior authorization and medical necessity processes, benefit verification and assistance 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 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 . Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position. EXPECTATIONS OF THE JOB: Assist callers with benefit verifications and providing support related to coverage, out-of-pocket costs and prior authorizations as needed Triage to appropriate third party support centers Focus on results in a professional, ethical, and responsible manner when dealing with patients, caregivers, customers, vendors, team members, and others. Accepts being accountable and responsible in work practices and expectations. Delivers what is promised. Fosters a collaborative, team-oriented attitude. Communicates effectively with others with clarity and transparency. Uses innovative critical and creative thinking to evaluate and solve work and customer issues. Seeks assistance in solving work problems through collaboration and information seeking. Learn, understand and follow all company and client policies and procedures. Excellent attendance Must be able to work rotating 8 hour shifts Monday through Friday. The above list reflects the general details necessary to describe the expectations of the position and shall not be construed as the only expectations that may be assigned for the position. An individual in this position must be able to successfully perform the expectations listed above. Qualifications: Qualifications MINIMUM KNOWLEDGE, SKILLS AND ABILITIES: The requirements listed below are representative of the experience, education, knowledge, skill and/or abilities required. 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. PREFERRED QUALIFICATIONS: Customer service and/or contact center experience. Reimbursement/Patient Services experience. PHYSICAL/MENTAL DEMANDS AND WORKING ENVIRONMENT: The physical and mental requirements along with the work environment characteristics described here are representative of those an individual encounters while performing the essential functions of this position. Office: While performing the essential functions of this job the employee is frequently required to reach, grasp, stand and/or sit for long periods of time (up to 90% of the shift), walk, talk and hear; occasionally required to lift and/or move up to 25 pounds. The noise level in the work environment is usually moderately quiet, with frequent interruptions and multiple demands. #INP Additional Information OUR CULTURAL BELIEFS: Patient Minded I act with the patient's best interest in mind. Client Delight I own every client experience and its impact on results. Take Action I am empowered and empower others to act now. Grow Talent I own my development and invest in the development of others. Win Together I passionately connect with anyone, anywhere, anytime to achieve results. Communication Matters I speak up to create transparent, thoughtful and timely dialogue. Embrace Diversity I create an environment of awareness and respect. Always Innovate I am bold and creative in everything I do. Our team is aware of recent fraudulent job offers in the market, misrepresenting EVERSANA. Recruitment fraud is a sophisticated scam commonly perpetrated through online services using fake websites, unsolicited e-mails, or even text messages claiming to be a legitimate company. Some of these scams request personal information and even payment for training or job application fees. Please know EVERSANA would never require personal information nor payment of any kind during the employment process. We respect the personal rights of all candidates looking to explore careers at EVERSANA. From EVERSANA's inception, Diversity, Equity & Inclusion have always been key to our success. We are an Equal Opportunity Employer, and our employees are people with different strengths, experiences, and backgrounds who share a passion for improving the lives of patients and leading innovation within the healthcare industry. Diversity not only includes race and gender identity, but also age, disability status, veteran status, sexual orientation, religion, and many other parts of one's identity. All of our employees' points of view are key to our success, and inclusion is everyone's responsibility. Consistent with the Americans with Disabilities Act (ADA) and applicable state and local laws, it is the policy of EVERSANA to provide reasonable accommodation when requested by a qualified applicant or candidate with a disability, unless such accommodation would cause an undue hardship for EVERSANA. The policy regarding requests for reasonable accommodations applies to all aspects of the hiring process. If reasonable accommodation is needed to participate in the interview and hiring process, please contact us at . Follow us on LinkedIn | Twitter

Created: 2024-11-03