Verification Specialist, Reimbursement
Source of Future Technology, Inc. - Cambridge, MA

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SOFT's client located in Cambridge, MA is looking for a Verification Specialist, Reimbursement for a contract assignment.

Job Responsibilities/Department description:
- Reimbursement Expertise (National & Regional Levels)
- Establish and maintain a strong understanding of product reimbursement though Medicare Part D, state Medicaid, and government and commercial prescription drug plans.
- Keep current on all available Patient Assistance Programs, State Pharmacy Assistance Programs (SPAPs), and government and independently sponsored alternative funding programs.
- Process a high volume of assistance requests received from healthcare providers and enter information into Sales Logix database in a timely and accurate manner.
- Perform Verification of Benefits (VOBs) for patients who are clinically appropriate for products and enter information into Sales Logix database in a timely and accurate manner.
- Provide appropriate information to patients, their families, physicians, health care professionals, and insurance carriers on the coverage and benefits of products.
- Facilitate Prior Authorizations, Formulary Exceptions, and/or other step edit requirements for Products.
- Collaborate with Renassist team members, professionals, and insurance companies to troubleshoot and resolve reimbursement-related issues.
- Relationship Building & Customer Service
- Initiate and maintain strong working relationships with key stakeholders at physician offices and dialysis centers to facilitate effective case management. Includes, but is not limited to: renal dieticians, social workers, physicians, nurses, facility administrators and medical assistants.
- Answer and address calls from the Renassist Helpline; document all pertinent information on callers into SalesLogix database.
- Interact via phone with pharmacies, insurance companies, professionals, and Renal Business Unit colleagues.
- Partner with internal Renassist counterparts to effectively manage regional reimbursement needs.
- Communicate results of Verification of Benefits to Clinical Science Specialists and work as a team to ensure patients' access to therapy.
- Limited travel may be required for National, Zone, and Regional meetings.

Workload Management
- Required to manage a high volume of external customer assistance requests.
- Expected to review assistance request results with customers and Clinical Science Specialists.
- Provide customer follow up to facilitate successful transitions from free drug to obtaining drug through new insurance prescription drug plans.
- Assist team with overflow of work when required.
- Perform in a Regulated Environment
- Securely store and maintain patient records while complying with HIPAA regulations.
- Comply with all state and federal healthcare and pharmaceutical laws and regulations.
- Work with customers and coworkers in a professional and ethical manner.

Skills Required: Strong relationship building skills with internal and external customers. Ability to overcome product access & reimbursement obstacles to directly impact patient care. Effective workload management.
Ability to multitask and prioritize tasks independently. Exceptional customer service. Strong problem solving & decision making skills.

Basic Qualifications: Working knowledge of insurance benefits. Experience working in a team environment. Ability to work independently.
Preferred Qualifications: Bachelor's degree, 3-5 years professional experience or Master's and 1-3 years. Ability to multitask, developed customer service skills, can accurately identify the needs of the customer, obtains a comprehensive understanding of Renassist's access and patient assistance services, well organized, efficient, consistently meets established deadlines, strong attention to detail, sense of urgency, strong collaboration skills. SalesLogix database experience a plus.

Source of Future Technology, Inc. - 30+ days ago - save job - copy to clipboard