RCM OPH/Drug Reimbursement Specialist
Eye Care Partners Career Opportunities•Monmouth Beach, NJ
•Hybrid
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.
Requirements
- High School Diploma or GED
- 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
Nice To Haves
- Previous medical office experience preferred
- Previous ophthalmic experience strongly preferred
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 request
- 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 patient's 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.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
Number of Employees
501-1,000 employees
