Reimbursement Specialist I

Portland, OR 97232

Posted: 07/30/2019 Employment Type: Contract Industry: Commercial Operations/Customer Care Job Number: 6609

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.

 

Duties:
  • Investigate patient’ s insurance benefits.
  • Identify network providers, provider restrictions, and co-pays as needed.
  • Document requirements for prior authorization and medical review process.
  • Document activities appropriately in progress notes.
  • Pursue product coverage for patients in accordance with the payer’ s authorization requirements within the departments established performance criteria.
  • Maintain payer profiles by recording payer specific data promptly into the system.
  • Convey outcomes of benefit investigation to internal contacts (i.e. case managers).
  • Learn processes for multiple products and effectively apply learnings to provide effective reimbursement services.
  • Conduct all work in a compliant manner.
  • Consult with team members on an as needed basis.
  • Periodic mandatory overtime throughout the year is required.  This may include, but is not limited to, high referral season (Enrollment renewal), new product or system launches, new line extensions, or any unexpected surge in volume or backlog situations. May include weekends as needed.

 

Skills:

  • Bachelor’s degree is preferred or equivalent experience.
  • A minimum of 3 years reimbursement experience is preferred.
  • Knowledge of managed care industry including government payers.  
  • 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.
  • 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 delegate next steps to appropriate team members.
  • Demonstrates effective problem solving and excellent customer service.
  • Exceptional attention to detail and ability to prioritize tasks.
  • Must be able to follow written Standard Operating Procedure.

 

Education:

  • Bachelor’s degree is preferred or equivalent experience.
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