Reimbursement Specialist

Johnson & Johnson•Orlando, FL

2d•Remote

About The Position

Our expertise in Innovative Medicine is informed and inspired by patients, whose insights fuel our science-based advancements. Visionaries like you work on teams that save lives by developing the medicines of tomorrow. Join us in developing treatments, finding cures, and pioneering the path from lab to life while championing patients every step of the way. Learn more at https://www.jnj.com/innovative-medicine We are searching for the best talent for a Reimbursement Specialist to be in Pittsburgh, PA, Raleigh, NC, Phoenix, AZ, or Orlando, FL. Purpose: The Reimbursement Specialist (RS) is a professional role that handles payer inquiries, manages benefit investigations to determine patient eligibility and coverage, and addresses coverage challenges. This role serves as the main contact for payers and collaborates cross-functionally to support the patient service program.

Requirements

High school diploma or equivalent.
Minimum of 2 years of experience in case management or insurance roles preferably within a pharmacy, HUB, or healthcare setting.
Experience using an outbound calling platform to make external calls
Ability to independently manage case load, prioritize work, and use time management skills to meet service level agreements
Ability to efficiently navigate multiple screens and systems to perform work.
Ability to work assigned 8 hr shift between program operating hours of 8am-8pm EST.
Proven ability to manage a case load, prioritize tasks, and build relationships.
Apply company policies and procedures to resolve challenges
Ability to proficiently use Microsoft programs.
Ability to thrive in a regulated, remote, high-volume environment

Nice To Haves

Undergraduate Degree
Understanding of plan types – Government, Commercial, Medicaid, VA, Fed
Knowledge of insurance structure (ex PBM’s, major medical plans, co-pay assistance /cards)
Working Knowledge of Third-Party and other Foundation programs
Basic understanding of Co-Pay Assistance
Understanding of HUB patient journey, workflow, and triage is a plus.
Possess a strong understanding of biologic/specialty pharma market and patient access challenges

Responsibilities

Assess and analyze patient benefits in coordination with internal program operations, insurance providers, and specialty pharmacy liaisons.
Work independently to complete assigned work in accordance with Standard Operating Procedures and defined service levels to review benefit verification process, resolve coverage challenges, and answer inquiries.
Use high-level problem-solving skills to research cases and resolve independently using creativity, innovation, and professional judgement to make sound decisions.
Maintain frequent phone contact with payers to gather all necessary information related to case/patient information, insurance coverage, prior authorization (PA) and appeals processing.
Efficiently process patient and prescriber requests to accelerate access to therapy.
Serve as expert on payer trends, product access, and reporting reimbursement insights and/or delays, i.e., denials or delays.
Frequently communicate with program management on new insurance requirements and trends.
Collaborate with internal & external stakeholders by providing reimbursement information as needed
Maintain accurate, compliant documentation and communication to support program goals.
Uphold patient privacy laws and foster collaborative team relationships.
Other duties as assigned.