Reimbursement Specialist I
South San Francisco, California | Contract
Our client is a leading biotechnology company that discovers, develops, manufactures and commercializes medicines to treat patients with serious or life-threatening medical conditions. They are among the world' s leading biotech companies, with multiple products on the market and a promising development pipeline.
The Reimbursement Specialist investigates patients insurance benefits and obtains prior authorization information of products at the patient/family request.
- Investigates patients insurance benefits
- Identifies network providers, provider restrictions, co-pays 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 departments established performance criteria
- Maintains payer profiles by recording payer specific data promptly into the system
- Convey outcomes of benefit investigation to internal contacts (i.e. case managers)
- Ability to learn processes for multiple products and effectively apply learnings to provide effective reimbursement services
- Conducts all work in a compliant manner
- Consults with team members on an as needed basis
- This position requires some flexibility in work shift
- Periodic mandatory overtime throughout the year is required in Access Solutions Operations. This may include, but is not limited to, high referral season, new product or system launches, enrollment renewals, new line extensions, or any unexpected surge in volume or backlog situations.
- Workdays are M-F, but may include weekends as needed.
The successful candidate will demonstrate the following competencies critical to this role:
- Communication – Listens well; expresses ideas fluently and logically; is open to input and can be depended on for truthfulness
- Inspiring and Influencing – Fosters an exchange of ideas and support; persuades and influences without authority
- Teamwork and Collaboration – Creates atmosphere of openness and truest’ collaborates; offers support and encouragement
Achieving Results – Is goal directed and persistent; is accountable for meeting commitments; recognizes the contributions of peers:
- Bachelors degree is preferred
- A minimum of 3 years reimbursement experience preferred
- Proficient in all aspects of reimbursement (i.e., benefit investigations, payer reimbursement policies, regulatory and administrative rules)
- Understands reimbursement/funding resources and how to access these resources
- Knowledge of managed care industry including government payers
- Excellent investigational and analytical skills with a proven ability to communicate effectively in both written and verbal format
- Ability to work collaboratively in a team structure and responsibly delegates next steps to appropriate team members
- Demonstrates effective problem solving and excellent customer service
- Exceptional attention to detail and ability to prioritize tasks
- Bachelor's degree is preferred