Pay Rate: $16 - $17/hr
Under the general supervision of the Supervisor and Manager, the Reimbursement
Specialist is responsible for various reimbursement functions, including but not limited to
benefit investigations, prior authorization support, and call triage. The Reimbursement
Specialist responds to all provider account inquiries, appropriately documents all
provider, payer and client interactions into the CareMetx Connect system and ensures
that the necessary data for prior authorization requests are obtained.
PRIMARY DUTIES AND RESPONSIBILITIES:
Collects and reviews all patient insurance benefit information, to the degree
authorized by the SOP of the program.
Provides assistance to physician office staff and patients to complete and submit
all necessary insurance forms and program applications.
Completes and submits all necessary insurance forms in a timely manner as
required by all third party payors for prior authorizations. Tracks and follow up on
prior authorization request.
Provides exceptional customer service to internal and external customers;
resolves any customer requests in a timely and accurate manner; escalates
Maintains frequent phone contact with provider representatives, third party
customer service representatives, and pharmacy staff.
Reports any reimbursement trends/delays to the supervisor.
Processes any necessary insurance/patient correspondence.
Provides all necessary documentation required to expedite prior authorization
request. This includes demographic, authorization/referrals, National Provider
Identification (NPI) number, and referring physicians.
Coordinates with inter-departmental associates as necessary.
Communicates effectively to payors to ensure accurate and timely benefit
Works on problems of moderate scope where analysis of data requires a review
of a variety of factors. Exercises judgment within defined standard operating
procedures to determine appropriate action.
Typically receives little instruction on day-to-day work, general instructions on
Performs related duties as assigned
EXPERIENCE AND EDUCATIONAL REQUIREMENTS:
Previous 2+ years of experience in a physician’s office, healthcare setting, and/or
Previous supervisory experience is preferred.
MINIMUM SKILLS, KNOWLEDGE AND ABILITY REQUIREMENTS:
Ability to communicate effectively both orally and in writing.
Ability to build productive internal/external working relationships.
Strong interpersonal skills.
Strong negotiating skills.
Strong organizational skills; attention to detail.
General knowledge of pharmacy benefits, and medical benefits.
Global understanding of commercial and government payers preferred.
Ability to proficiently use Microsoft Excel, Outlook and Word.
Ability and initiative to work independently or as a team member.
Ability to problem solve.
Strong time management skills.
Customer satisfaction focused.