This individual will work directly with the General Manager and/or Operations Manager to help develop and implement a newly created clinical reimbursement function within our national specialty pharmacy. this function will be providing assistance and support companywide with reimbursement for patients, family members, caregivers, nurses, physicians, and or pharmacists. In this role the individual will build the reimbursement function that will address reimbursement related inquiries, assess patients' coverage options, provide eligibility and benefit verification, secure insurance authorizations, advocate for maximum reimbursement coverage on a case-by-case basis from third party payers, and provide financial support by obtaining funding through 501c(3) organizations, pharmaceutical manufacturer assistance programs, as well as other financial support programs where applicable.
The Clinical Reimbursement Specialist will also assure the management of the Medicare and Managed Care reimbursement for our national specialty mail order pharmacy and will be responsible for regulatory compliance in order to attain the appropriate Medicare reimbursement possible for assigned facilities.
ESSENTIAL ELEMENTS OF THE JOB:
Maintain accountability for day-to-day patient reimbursement activities, workload and overall workflow.
Work on patient's behalf to identify and assess reimbursement coverage options for those with insurance and to coordinate and/or investigate financial options for those without insurance.
Work with physician offices and other Avella retail locations to facilitate the process of obtaining financial assistance in order to maximize patients' access to treatment.
Monitor, follow-up with and record all financial re-authorizations required by foundations to help ensure compliance and continuity of treatment.
Work with manufacturer assistance programs when they become the “payer of last resort” to gain access to medications for patients.
Collaborate with Clinical team to maintain database for recording, managing, and monitoring patient activities for those requiring reimbursement support.
Provide and analyze data for reporting and trending related to reimbursement Maintain a collaborative approach with members of call center team, retail locations, provider offices, and external partnerrs.
Demonstrate the utmost sensitivity and confidentiality to information while maintaining a high level of professionalism.
Assume additional projects on an as needed basis.
ESSENTIAL SKILLS AND EXPERIENCE:
Minimum 3 years of experience in a similar role on a full-time basis with preferred experience in reimbursement, prior authorization and other funding sources experience required.
Minimum 2 years of experience in a customer service role required.
Certified Pharmacy Technician required
Demonstrated experience in producing a high level of accuracy across all job responsibilities and finished work product
High level computer proficiency with customer contact databases, Windows, Word and Excel required
Demonstrated ability to successfully manage multiple, competing priorities.
Proven ability to work with minimal direction to complete day to day responsibilities.
Experience with pharmacy systems and Microsoft Office preferred
High School Diploma or Equilavent
TYPICAL WORK CONDITIONS:
· Work in a call center and specialty pharmacy environment
· Full-time position. Work hours may exceed 40 hours per week.
· Fast paced work environment
· Use of phone system and computer throughout the day
We are proud to be an EEO employer M/W/D/V.