The Specialty Pharmacy Reimbursement Specialist performs specific reimbursement functions for completing a medical and/or pharmacy benefit investigation. In this role, you will utilize transaction data to complete a medical benefit investigation. This process involves calling on specific payers to obtain the necessary missing data to finalize the benefit investigation. Once the data is obtained from the payer, the Reimbursement Specialist will enter the data into the Company's system using pre-established protocols. In addition, you may also complete other documentation as required for daily reporting and performance measurement activities. This position is allowing WFH for Charlotte, NC area residents (NC and SC residents encouraged to apply; the client is in SW Charlotte!). Must be in the area to pick up equipment (it will not be shipped). Please only apply if you are local to Charlotte metro area.
- Collects and reviews all patient insurance benefit information from the payer to the degree authorized by the SOP of the program.
- Provides exceptional customer service to all internal team members; resolves any requests in a timely and accurate manner; escalates issues accordingly.
- Maintains frequent phone contact with assigned payers.
- Reports any reimbursement trends/delays to the supervisor.
- Coordinates with inter-departmental associates, as necessary.
- Communicates effectively to payers to ensure accurate and timely benefit investigations.
- 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.
- Achieves or exceeds daily and weekly performance targets for BV completion.
- Ability to work remotely; typically receives little instruction on day-to-day work
- High School, Diploma, or GED
- 1-2 years of experience in a specialty pharmacy, medical insurance, physician's office, healthcare setting, and/or related experience
- Proficient in MS Office (Microsoft Excel, Outlook, and Word)
- This position is allowing WFH for Charlotte, NC area residents (NC and SC residents encouraged to apply; the client is in SW Charlotte!). Must be in the area to pick up equipment (it will not be shipped). Please only apply if you are local to Charlotte metro area.