Reimbursement Specialist

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    "requisitionDescription": "<div><p data-pasted=\"true\"><u>Position Objective</u>: The Reimbursement Specialist researches and investigates drug or treatment specific coverage and benefits to assist MDOs (medical doctors&rsquo; offices).</p><p><br></p><p><u>Accountability</u>: The incumbent will report to the Program Manager.</p><p>&nbsp;&nbsp;</p><p><u>Essential Functions</u>:</p><ul type=\"disc\"><li>Handles benefit request investigations submitted by MD offices. Investigations to be conducted via test claim, eBV and/ or phone.&nbsp;</li><li>Contacts insurance companies directly to obtain patient&rsquo;s specialty pharmacy and prescription benefits.</li><li>Updates pharmacy claim processing info i.e. BIN, PCN, ID and Group numbers in the patient record.</li><li>Document detailed pharmacy benefit results with the appropriate information regarding patient&rsquo;s pharmacy benefits and network pharmacy details according to the established triage rules and procedures.</li><li>Handling, detecting and fixing errors within the system to ensure proper benefit retrieval.</li><li>Identify and escalate priority issues to the Case Manager or Program Manager.</li><li>Route information and coverage results appropriately to the Case Manager.</li><li>Follow up on Prior authorization status as required based on business rules.</li><li>Document all call information according to standard operating procedures.</li><li>Review referral and case for information accuracy and completeness, including but not limited to, patient demographics, pharmacy card processing information, prescription quantity, dose, directions and diagnosis code.</li><li>Document missing information if any and relay to the Case Manager for HCP or patient outreach as needed.</li><li>Performs other duties as assigned by the Program Manager or the Team Lead.</li></ul><p style=\"line-height: 1.5;\"><u>Knowledge, Skills &amp; Abilities</u>:</p><ul type=\"disc\"><li><p>Associate&rsquo;s degree or equivalent from a two-year college, technical school or certificate program in pharmacy and/or healthcare, preferred. High School Diploma or GED, required.</p></li><li><p>1-2 years&#39; experience in pharmacy or insurance verification environment (i.e. hub services, pharmacy, doctor&#39;s office, health plan member services, etc.), required.</p></li><li><p>Experience in pharmacy benefit investigation, retail pharmacy or specialty pharmacy adjudication, required.</p></li><li><p>Knowledge in call center telephony technology</p></li><li><p>High level of customer service, interpersonal skills, and highly effective in working objectively with a diverse group of people.</p></li><li><p>Excellent verbal/written communication skills, self-discipline, and attention to detail.</p></li><li><p>Proficient in data entry, computer skills, and able to learn the department&rsquo;s software system.</p></li><li><p>Must be a team player willing to accept organizational and team goals, and function with minimal supervision.</p></li><li><p>Maintain HIPAA patient confidentiality, as well as discretion regarding proprietary company information.</p></li><li><p>Adaptable, able to shift gears and focus based on company and team needs.</p></li></ul></div>\n",
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