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Reimbursement Specialist

1 month ago

Tempe, United States Synectics Full time
Job DescriptionJob Description

Client: Novartis

Hybrid- Tempe, AZ

Contract role for 9 months with possibility of extension based on performance. 

Description:

  • The Reimbursement Specialist will be responsible for providing support and information about the insurance coverage of their prescribed medicines.

  • They will accurately and efficiently find the patient's insurance coverage, and any other requirements by leveraging reimbursement tools and collaborating with payers and providers.

  • The Reimbursement Specialist may also share appropriate information with Patient Specialty Services field teams. This information may cover coverage-related queries from customers, provide pre-authorizations for medical treatment, and outline information regarding co-payments.

  • The Reimbursement Specialist must have strong communication skills to converse with payors and providers about benefits coverage and be able to offer solutions in accordance with approved procedures.

  • A Reimbursement Specialist will possess an aptitude for learning and continual development.

  • Your responsibilities will include, but are not limited to:

  • Develop and maintain knowledge of PSS programs and payer coverage; broaden program knowledge over time.

  • Learn and utilize protocols, information and technology to gather patient coverage information.

  • Some of this will be completed via phone calls to payers in a prompt and courteous manner.

  • Prepare proper documentation and notifications; perform proper escalation, tracking, and follow-up

  • Evolve skills to navigate the payer landscape regarding programs over time

  • As applicable, raise innovative ideas which will drive improved efficiency and effectiveness of customer service to Team Leads.

  • Calling Pharmacy Benefit Managers as well as medical payers to obtain patient' benefits (i.e., confirming plan details, obtaining cost information, patient responsibility, prior authorization/appeal requirements, etc.).

  • Calling the payers to follow up on the status of the coverage exceptions (PA, appeal, NFE).

  • Documenting this information and sending it via fax to healthcare providers

Qualifications:

  • High School Diploma required

  • At least 6 months of proven Reimbursement Experience (such as Healthcare, Payers or Pharmaceuticals,)

  • Experience and exposure in balancing multiple priorities with multiple audiences

  • Experience working with data entry system(s), fax machines, computer software, and telephone technology

  • Strong phone and verbal communication skills - ability to follow oral and written directions

  • Good problem-solving and critical thinking skills

  • Ability to interpret, capture and document the details of payer conversations, in a timely and efficient manner

  • Computer literacy with email, video conferencing systems and data entry systems

  • Preferred: 1 year of Reimbursement Specialist experience within a Customer Contact Center in the Pharmaceuticals industry