Reimbursement Specialist

Danville, California | Contract

Post Date: 06/22/2016 Job ID: 1684 Industry: Managed Care

Duties:
  • Investigates patient' s 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 payor' s authorization requirements within the department' s established performance criteria.
  • Create written communication to customers regarding reimbursement status.
  • Maintains payor profiles by recording payor specific data promptly into the system. Consults with team members on an as needed basis.
  • Collects and enters data for distributor referral cases.

 

Skills:
  • 4 years experience in Healthcare reimbursement required; verifying benefits, prior authorizations and working with public and private insurance.
  • Must be able to drive for results.
  • Proficient in all aspects of reimbursement (i.e. benefit investigation, pay reimbursement policies).
  • 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.
  • Requires computers skills including MS Excel.

 

MUST HAVES:

1) Medical Insurance payer knowledge - demonstrated in phrases: Benefit investigations/ verifications, prior authorizations, Insurance networks, Specialty Pharmacies, Pharmacy Benefit managers, Major Medical.

2) 2+ years experience verifying medical benefits.

3) Evidence of experience verifying benefits with Private payers. 

4) Evidence of experience working with Public payers (Medicare & Medicaid).

5) Proficient computer skills.

6) Work in team environment.

 

NICE TO HAVES:

1) Experience with Medicare Part B & Medicare Part D. 

2) Work at a reimbursement service company. 

3) Evidence of thorough knowledge of the public & private payer landscapes.

4) Work at or with a specialty pharmacy.

 

Education:

  • BS/BA preferred or relevant experience.
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