Reimbursement Specialist

EVERSANA•Mason, OH

8d•Onsite

About The Position

The Reimbursement Specialist primarily responsible is to interface with Patients, HCPs and Payers by providing reimbursement support for activities related to benefit coverage, prior authorization, claim denials, appeals, triage to third party support centers and general inquiry. Our employees are tasked with delivering excellent business results through the efforts of their teams. These results are achieved by: Provide dedicated and personalized support delivered over the phone, CRM, and email. Complete investigations and answer questions regarding insurance benefits, including information about coverage and out-of-pocket costs. Assist with prior authorization and medical necessity processes, benefit verification and assistance in a manner that is consistent with industry best practice. Determine when call reason is best handled by third party support center and triage accordingly. Maintain positive attitude and a helpful approach to customers and clients. Conduct enrollment intake for all incoming inquiries. Participate in continuous quality improvements and training opportunities. All other duties as assigned . Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.

Requirements

Strong pharmacy reimbursement experience, especially understanding of prior authorization process
Experience conducting benefit verifications with payers preferably supporting retail prescription drug products.
Knowledge of healthcare administration and specifically healthcare billing and reimbursement procedures and regulations
Knowledge of Retail Pharmacy Operations preferred
Excellent oral, written, and interpersonal communication skills.
Ability to multi task.
Positive attitude.
Accurate and detail-oriented.
Ability to work independently and function as a team player.
Ability to work in a fast paced, metric driven environment, while remaining patient minded.
Strong computer skills with a working knowledge of Microsoft Word, Excel, and PowerPoint.

Nice To Haves

Customer service and/or contact center experience.
Reimbursement/Patient Services experience.

Responsibilities

Provide dedicated and personalized support delivered over the phone, CRM, and email.
Complete investigations and answer questions regarding insurance benefits, including information about coverage and out-of-pocket costs.
Assist with prior authorization and medical necessity processes, benefit verification and assistance in a manner that is consistent with industry best practice.
Determine when call reason is best handled by third party support center and triage accordingly.
Maintain positive attitude and a helpful approach to customers and clients.
Conduct enrollment intake for all incoming inquiries.
Participate in continuous quality improvements and training opportunities.
All other duties as assigned.