RCM/OPH Drug Reimbursement Specialist

Eye Care Partners Career•Ballwin, MO

16h•Remote

About The Position

Drug Reimbursement Specialists are responsible for communicating and working with patients to identify methods of payments. Works directly with insurance companies, drug assistance programs, and medical billing staff to manage billing and reimbursements for injectable medications. For remote team members, HIPAA compliant home office environment. Ability to work in a remote environment while performing required duties and remaining patient focused. Able to work varying shifts including early mornings/evenings to attend meetings and cross training or support other initiatives.

Requirements

High school diploma or equivalent required
Previous medical office experience preferred
Previous ophthalmic experience strongly preferred
Professional in appearance and actions
Logical and Critical thinking skills
Customer-focused with excellent written, listening and verbal communication skills
Enjoys learning new technologies and systems
Detail oriented, professional attitude, reliable
Exhibits a positive attitude and is flexible in accepting work assignments and priorities
Meets attendance and tardiness expectations
Management and organizational skills to support the leadership of this function
Ability to follow or provide verbal & written instructions with sufficient grammar and spelling skills to avoid mistakes or misinterpretations
Interpersonal skills to support customer service, functional, and team mate support need
Able to communicate effectively in English, both verbally and in writing
Ability for basic to intermediate problem solving, including mathematics
Basic to intermediate computer operation
Proficiency with Microsoft Excel, Word, and Outlook
Specialty knowledge of systems relating to job function
Knowledge of state and federal regulations for this position; general understanding of HIPAA guidelines

Responsibilities

Be proactive in running appointment reports to determine which patients will need a new prior authorization one to two weeks in advance
Keep authorization alerts in both EPM and EHR up to date
Be knowledgeable of all insurance plans, benefits, and coverage
Be available in the clinic during injections to assist in any insurance changes, billing questions or new patients requiring new assistance programs or authorizations.
Be available for patients to contact for assistance fund billing questions, assistance program information, enrollment, and re-enrollment
Have the knowledge to obtain and provide a benefit investigation to the requesting physician
Have the customer service skills to communicate with the patient in a way that the elderly patient can understand
Have the knowledge of insurance plans and which plans require step therapy-step edits
Keep communication with drug representatives regarding insurance changes and authorization requirements
Keep up to date on which doses of medication can be used with which diagnosis
Be able to fill out prescription information on all authorization forms and understand which chart notes are sufficient for authorization requests
Task Dr’s and scribes to make corrections to chart notes that are not sufficient for authorization request
Keep up to date on prescriptions with the specialty pharmacy for free medications
Knowledge of which insurance plans require their patients medication to be shipped from the preferred specialty pharmacy instead of buy and bill medications
Coordinate shipments every month for free drug patients
Document when shipments will be delivered and make sure they are put into refrigeration in a timely manner.
Adheres to all safety policies and procedures in performing job duties and responsibilities while supporting a culture of high quality and great customer service.
Performs other duties that may be necessary or in the best interest of the organization