Description
The Reimbursement Specialist focuses on resolving complex coverage and reimbursement issues that may create patient barriers to access for cell therapy. The individual in this role uses their knowledge of coverage, patient assistance programs and client resources to investigate and verify benefits and reduce patient access barriers. This role reports to the Senior Manager, Case Management and is considered Remote.
Key Responsibilities
Conduct benefits investigations and verifications for new cell therapy patients
Convey outcomes of benefit investigation to internal and external contacts (i.e. case managers and financial coordinators)
Coordinate with payers during the prior authorization process, including direct follow-up during appeals process if coverage is denied
Qualify patients for travel and lodging benefits in response to customer requests and manage referrals to external vendor for patients who are qualified
Respond to patient and customer questions about benefits as needed
Partner with Market Access and Payer Account team in support and development of customer facing materials
Ensure compliance with patient and customer services/support provided
Provide back-fill support for Intake Coordinators as needed (i.e., receive incoming data [such as travel / lodging applications, insurance cards, purchase order, trade policy cover] via fax or other sources and review, triage and route data to the appropriate department or team member as applicable)
Basic Qualifications
Bachelor’s degree
OR
Associates degree and 2 years of reimbursement experience
OR
High School Diploma and 3 years of reimbursement experience
Preferred Qualifications
Excellent investigational and analytical skills with the ability to inventively and effectively solve problems
Ability to work independently and in a team environment
Excellent investigational and analytical skills with the ability to inventively and effectively solve complex reimbursement problems
A proven ability to communicate effectively in both written and verbal formats
Ability to provide excellent customer service with high customer empathy
Proficient in all aspects of reimbursement (i.e., benefit investigations, payer reimbursement policies, regulatory and administrative rules) as well as claims and appeals process
Hospital billing and coding experience
Knowledge of managed care industry including government payers
Additional Details
- Onsite Offsite : Offsite