Reimbursement Specialist I

South San Francisco, California 94080 | Contract

Post Date: 03/12/2018 Job ID: 3990 Industry: Commercial Operations/Customer Care

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.




SCHEDULE: Candidates must have open availability from 5AM - 5PM depending upon business needs.

*** OTHER NOTES *** Training starts in MAY, however, the candidates will attend orientaiton at the end of April.
  • 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 (Blizzard, Enrollment renewal), 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 and 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
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