Job Title: Reimbursement Support Specialist
Reports To: Director, Case Management Rare Blood Disorders
About the Job
***'s Rare Blood patient support program is for people living with rare blood disorders, offering financial assistance, education, and access help throughout their *** prescribed therapy journey. The patient support organization consists of field teams that provide education to patients and health care providers to help patients start and stay on treatment as prescribed
The Reimbursement Support Specialist (RSS) will support and work collaboratively with Case Managers to facilitate the reimbursement process for our product portfolio. This role is an essential part of the case management process that requires a high level of organization and strong communication skills. The Reimbursement Support Specialist follows standardized workflows as defined by management. This is a skilled position that requires customer service, medical billing and/or healthcare insurance reimbursement experience. The RSS role is a support services function within a patient program and is not a patient-facing role.
Job Responsibilities:
Verify current insurance coverage policies and benefit details through direct contact with medical insurance providers and ensure prompt return of accurate information to facilitate the initiation and ongoing continuity of treatment
Research and identify insurance company prior authorization processes and provide necessary documents and requirements to Case Management team members
Follow up with payers to determine status of prior authorizations for enrolled patients
Re-verify insurance benefits as needed for the patients
Research denied and incomplete claims to address potential barriers impacting access to continued treatment
Track and follow up on in-process claims and denials to the point of resolution providing ongoing cross functional updates
Assist Patient Support Services team in the resolution of copay claim issues related to *** Copay Assistance Program
Process new enrollment forms
Provide quality phone customer service to inbound callers
Coordinate with the Reimbursement Support Specialist team to efficiently assign and distribute tasks from the shared work queue
Maintain up-to-date knowledge of the reimbursement process, billing/coding guidelines, dose calculations, healthcare policy, insurance plans, payer trends, financial assistance programs, and related resources
Complete daily documentation of all interactions and input accurate data on each individual cases, their insurance, coverage approvals and ongoing coverage requirements in CRM Database while maintaining compliance with HIPAA and other regulating bodies as required
Establish proficiency and full understanding of *** Patient Support Services Customer Relationship database including undertaking of data elements, case statuses and outcomes, and documentation requirements
Ensure full compliance with *** policies, procedures, and guidelines
[strong style= "box-sizing: inherit; margin: 0px; padding: 0px; "]Minimum Requirements:
AA Degree required, Bachelors Degree preferred
1-3 years' experience in health insurance reimbursement or equivalent applicable work experience preferred
Demonstrated ability to handle sensitive and confidential information, including patient personal data (PII/PHI), with discretion and care at all times
Effective communication, problem-solving and negotiation skills
Ability to think critically and problem solve to address customer needs
Ability to work in a fast-paced environment
Experience working in a high-volume patient services program preferred
Experience with Salesforce CRM preferred
Proficient with MS Word, MS Excel, and MS PowerPoint
Working hours may vary based on business needs and team coverage