USA-Documentation Specialist II (Administrative)

Adecco Healthcare & Life Sciences is hiring a contract hybrid Reimbursement Resource Specialist for our Pharmaceutical partner in Cambridge, MA. The anticipated hourly wage for this position is between $35 and $36.25. Hourly wage may depend upon experience, education, geographic location, and other factors. Benefit offerings include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and 401K plan. Our program provides employees the flexibility to choose the type of coverage that meets their individual needs. Available paid leave may include Paid Sick Leave, where required by law; any other paid leave required by Federal, State, or local law; and Holiday pay upon meeting eligibility criteria Internal title: Reimbursement Resource Specialist Job Purpose: The Reimbursement Support Specialist will support and work collaboratively with Case Managers in the Rare Blood Disorders business to support enrollment processing for our Rare Hematology portfolio, assist with the facilitation of the reimbursement process for our Rare Hematology product portfolio, which includes assisting with benefit investigations and being the first in line for inbound calls. This role is an essential part of the case management process that requires a high level of organization and strong communication skills. The Reimbursement Support Specialist follows standardized workflows as defined by management. This is a skilled position that requires customer service and/or healthcare insurance reimbursement experience. Job Responsibilities: • Assist with the verification of insurance coverage policies and benefit details through direct contact with medical insurance providers with prompt communication of accurate information to facilitate the initiation and ongoing continuation of treatment • Research and identify insurance company prior authorization processes and provide necessary documents and requirements to Case Management team members • Re-verify insurance benefits and coverage as needed to assist the Case Management Team with prompt service for Patients and Facilities. • Assist case management team in the resolution of co-pay claim issues related to Co-Pay Assistance Program • Coordinate within the functional Reimbursement Support Specialist team to ensure efficient assignment and distribution of tasks from the shared work queue • Maintain up-to-date knowledge of the reimbursement process, healthcare policy, insurance plans, payer trends, financial assistance programs, and related resources • Complete daily documentation of all interactions and input accurate data, which includes inbound phone calls, prescription information, insurance and PBM information, coverage approvals and/or denials, prior authorization information and ongoing coverage requirements in iCare Database while maintaining compliance with HIPAA and other applicable healthcare and privacy regulations • Establish proficiency and full understanding of the Rare Blood Disorders Patient Support Services Customer Relationship database including understanding of data elements, case statuses and outcomes, and documentation requirements • Receive and report all Adverse Events and Product Technical Complaints to Pharmacoviligence in accordance with Rare Blood Disorders and FDA rules and regulations. Qualifications: • Reimbursement Resource Specialist • Bachelor's degree required • 4-5 years' experience in health insurance reimbursement, medical billing, or equivalent applicable work experience • Effective communication, problem-solving and negotiation skills required. • Ability to think critically and problem solve to address customer needs. • Ability to work collaboratively and independently in a fast-paced environment • Experience working in a high- volume patient services program preferred. • Experience with Salesforce CRM preferred. • Spanish Speaking is essential • Proficient with Microsoft Office, Word, Excel, and PowerPoint • Ability to be on-site 2-3 days per week. Pay Details: $35.00 to $36.25 per hour Benefit offerings available for our associates include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and a 401K plan. Our benefit offerings provide employees the flexibility to choose the type of coverage that meets their individual needs. In addition, our associates may be eligible for paid leave including Paid Sick Leave or any other paid leave required by Federal, State, or local law, as well as Holiday pay where applicable. Equal Opportunity Employer/Veterans/Disabled To read our Candidate Privacy Information Statement, which explains how we will use your information, please navigate to The Company will consider qualified applicants with arrest and conviction records in accordance with federal, state, and local laws and/or security clearance requirements, including, as applicable: The California Fair Chance Act Los Angeles City Fair Chance Ordinance Los Angeles County Fair Chance Ordinance for Employers San Francisco Fair Chance Ordinance

Created: 2024-11-05