Reimbursement Specialist

• Provide inbound and outbound phone support as the primary contact for patients, caregivers, and providers
• Coordinate and monitor patient needs throughout the Patient Support Program journey
• Handle day-to-day reimbursement services activities
• Interact with healthcare insurance companies to verify financial aspects of healthcare services
• Advise patients on eligibility requirements, program enrollment, reimbursement processes, affordability support, and therapy access
• Establish relationships and maintain rapport with patients, payers, and healthcare providers
• Provide ongoing support and program information to healthcare providers
• Verify insurance coverage, medical billing, reimbursement processes, and access for complex pharmaceuticals
• Evaluate program enrollment forms for data integrity
• Conduct insurance benefit investigations and triage cases according to standard operating procedures
• Follow program guidelines and escalate complex cases according to policies, SOPs, Call Guides, and program materials
• Maintain case records and document status and background in the case management system
• Communicate patient benefits and assist with prior authorization and appeals processes
• Explain benefits offered by private/commercial and government payers, including Medicare, Medicaid, VA, and DOD
• Liaise with client contacts, Program Management, internal stakeholders, and healthcare providers
• Maintain records according to applicable standards and regulations
• Serve as a brand advocate and program representative while delivering customer service and quality outcomes
• Collaborate with the Program Manager regarding patient status, prescriber feedback, satisfaction, and program effectiveness
• Maintain confidentiality and privacy
• Meet training deadlines and follow all SOPs
• Perform additional assigned tasks or projects

• Compile, analyze, and report on departmental operating-unit performance
• Analyze departmental-specific reports and provide feedback
• Ensure accurate and compliant charge items and resolve billing inconsistencies using clinical and coding knowledge
• Coordinate projects and audits to improve revenue-cycle processes, charging and billing efficiency, and collection efforts
• Provide historical information to assist management with forecasting
• Work with departmental directors, managers, and personnel to ensure budgetary compliance
• Manage accounts-receivable and/or financial-reporting systems
• Prepare reports and analyses for PRMO, DUHS, and PDC leadership
• Coordinate communication among insurance companies, governmental agencies, providers, and support staff
• Trend and report departmental performance indicators and goals
• Recommend improvements to financial systems and conduct in-house operating-unit audits
• Assist with departmental goal and objective development
• Manage and delegate database inquiries when applicable
• Create work assignments and train employees
• Maintain professional relationships with internal and external agencies and professional organizations
• Serve as liaison between physicians and the PRMO when applicable
• Conduct employee quality reviews and provide feedback to management and employees when applicable
• Develop and provide job-specific training
• Perform other related duties

Reimbursement Specialist – Outpatient Medication Authorization

• Compile, analyze, and report on departmental operating-unit performance
• Analyze departmental reports and provide feedback
• Ensure accurate and compliant charge items and resolve billing inconsistencies
• Coordinate projects and audits to improve revenue-cycle, charging, billing, and collection processes
• Assist management with forecasting using historical information
• Work with directors, managers, and relevant personnel to ensure budgetary compliance
• Manage accounts-receivable and/or financial-reporting systems and prepare reports and analyses for PRMO, DUHS, and PDC leadership
• Coordinate communication among insurance companies, governmental agencies, providers, and support staff
• Track and report departmental performance indicators and goals
• Recommend improvements to financial systems and conduct operating-unit audits
• Help develop departmental goals and objectives
• Manage and delegate database inquiries when needed
• Create work assignments and train employees
• Maintain relationships with internal and external agencies and professional organizations
• Serve as liaison between physicians and the PRMO when needed
• Conduct employee quality reviews and provide feedback to management and employees
• Develop and provide job-specific training
• Perform other related duties