Reimbursement Specialist
Express-Scripts 1,231 reviews - Florida

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Provide the highest quality of customer service to patients, medical doctor's offices and client representatives, which entails acquiring in depth knowledge of client product and marketing requirements. The primary goal of this position is to effectively interface with patients, patient's families, national payers, home cares and medical doctor's offices in the successful pursuit of required information to: 1) Assist patient and medical provider in expediting the process of getting patient started on client product; and 2) Insure the highest level of reimbursement is attained for client product. This entails performance of the following responsibilities, either all or in part:

1. Conduct benefit investigations, verify insurance benefits on behalf of patient and Physicians' office, and submit and obtain prior authorization as required by payer.

2. Accurately enter data in all pertinent/required fields of client database. Effectively utilize the client database to monitor outstanding items on each client case file. Insure that all patient files are maintained and inclusive of all communications as well as medical and other documentation associated with working each case, allowing any other team member to clearly see what steps have been completed and determine the current status.

3. Provide coordination of order for product, shipment of product and therapy initiation with pharmacy and patient.

4. Participate in conference calls with Client Sales Representatives, Client management and Physicians┬┐ Offices regarding status of cases, drug orders and status of alternative funding.

5. Participate in Call Center Activities, which entails triaging incoming calls from patients, insurance companies, physicians, Sales Reps, pharmacies and homecare agencies.

6. Obtain recertification of Prior Authorizations for cases requiring extended treatment and coverage beyond the expiration of original approval.

7. Other duties as assigned

8. Responsible for good housekeeping techniques, adhering to quality and production standards while complying with all applicable company, state and federal safety and environmental programs and procedures.



Minimum High School Diploma or GED equivalent required. Bachelor's Degree preferred.

Five or more years' experience in the insurance, biotechnology, or pharmaceutical industries, in customer service and/or reimbursement.

Health Insurance claims or patient accounting experience a plus.

Knowledge of third party billing, coding, medical terminology, prior authorizations and appeals required.

Computer proficiency in MS Office applications, with database experience a plus.

Detail oriented with good analytical skills.

Ability to manage multiple priorities and meet deadlines.

Excellent written and verbal communication skills, with demonstrated successful ability to communicate with others at all levels.


Express Scripts is an Equal Employment Opportunity employer and does not discriminate in employment opportunities or practices on the basis of race, creed, color, religion, sex, national origin, nationality, ancestry, age, disability or status as a disabled veteran or veteran of the Vietnam era, pregnancy, affectional or sexual orientation, gender identity or expression, marital status, status with regard to public assistance, veteran status, citizenship or membership in any other legally protected class.

None of the questions in this application are intended to elicit information regarding any protected characteristics, nor imply any limitation, illegal preferences or discrimination based upon non-job-related information or protected characteristics.

Applicants must be able to pass a drug test and background investigation and, depending on position requirements, a Department of Defense background investigation. AA/EOE.

About this company
1,231 reviews
Express Scripts is a Fortune 25 company and is the largest pharmacy benefit manager in the U.S.