HealthCare Financial Reimbursement Analyst
About The Position
The role supports the Director of Revenue Integrity and Director of Patient Retention in the financial review process, ensuring cost-effectiveness by analyzing new referrals, existing patients’ health plan fee schedules, and other reimbursement databases. Key responsibilities include evaluating payer reimbursement methodologies, reviewing patient insurance benefits, and educating patients about available drug brands and copayment assistance programs. This position is designed to enhance patient onboarding and ongoing care by ensuring new and existing patients are informed of all available healthcare benefit options.
Requirements
- Associates degree.
- Minimum of 2 years of experience in specialty pharmacy setting
- Minimum of 2 years of experience with payer reimbursement methodologies within the healthcare revenue specialty reimbursement industry; experience with Medicare Part B & D is preferred.
- Strong attention to detail and organizational skills.
- Ability to manage multiple tasks and meet deadlines in a fast-paced environment.
- Effective verbal and written communication skills.
- Proficient in Microsoft Office applications and basic data entry functions.
- Ability to work independently and collaboratively within a team environment.
Nice To Haves
- Experience in specialty pharmacy, home infusion, medical billing, or copay assistance programs strongly preferred.
Responsibilities
- Assist with the reimbursement review and determination process within specialty operations.
- Review new referrals to ensure cost-effectiveness based on payer fee schedules and/or contracted rates, utilizing both In/Out-of-Network benefits from the patient’s health plan.
- Generate ad-hoc reports on profitability, cancellations, and other relevant categories.
- Educate and guide patients on AmeriPharma's products and services, including financial assistance options when applicable.
- Provide clear explanations of healthcare insurance benefits, including coverage details, copayments, deductibles, and network restrictions.
- Accurately document patient interactions, insurance details, and other relevant information in the electronic health record (EHR) system. Maintain confidentiality and comply with HIPAA and all applicable regulatory requirements.
- Foster a culture of accountability, integrity, collaboration, and service excellence.
Benefits
- Full benefits package including medical, dental, vision, life that fits your lifestyle and goals
- Competitive total rewards package
- Employee assistance program to assist with mental health, legal questions, financial counseling etc.
- Comprehensive PTO and sick leave options
- 401k program
- Plenty of opportunities for growth and advancement
- Company sponsored outings and team-building events
- Casual Fridays
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
