We are looking for an experienced Reimbursement Analyst to complete activity of the reimbursement hub program to which the employee is assigned. Includes researching and analyzing moderate to complex reimbursement policies. May include interaction with senior level client contacts. May also include handling of escalated cases/issues.
| TITLE: | Reimbursement Analyst |
| CATEGORY: | Customer Support |
| TYPE: | Non-Exempt, Hourly, Full or Part Time |
| JOB NATURE: | Office based desk position, Heavy phone and computer usage, minimal lifting. |
| JOB SUMMARY: | Completing activity of the reimbursement hub program to which the employee is assigned. Includes researching and analyzing moderate to complex reimbursement policies. May include interaction with senior level client contacts. May also include handling of escalated cases/issues. |
| JOB DUTIES: | Assist callers/clients with moderate to complex billing and coding, insurance benefit investigations, prior authorization, and appeals inquiries. May include acting as regional contact for senior level client contacts. Manage patient cases and interact with patients, healthcare providers, payers, and pharmaceutical and biotech manufacturer sales teams. Review and resolve denied or underpaid insurance claims. Identify and assess patient specific insurance coverage options for client specific products. Document all activities in program database within required timelines. Research payer medical policy. Monitor and update payer prior authorization requirements and coverage policies for specified client program. Prepare and/or assist with preparation of reports, as requested. Review and process documentation to determine patient specific eligibility for client patient assistance program(s), as appropriate. Host conference calls with senior level client contacts as required by program guidelines. Complete quality monitoring and quality assurance activities, as assigned. Travel to and attend client meetings, off site training, and/or conferences. Travel time estimate: 10%. |
| TRAINING, EDUCATION, EXPERIENCE: | Must be 18 years old or older. Bachelor's degree or relevant experience. Minimum four years recent healthcare experience (2 years' direct industry experience preferred). |
| REQUIREMENTS: | Advanced knowledge of medical insurance (public and commercial), billing and coding and associated terminology. Exhibit proficiency in Microsoft Office products. Excellent customer service skills (call center experience preferred). Advanced problem solving, research and analytical skills. Advanced communication skills, both written and verbal. Data entry accuracy required. Ability to multi-task and manage time independently. Client interaction experience preferred. |
| JOB RELATIONSHIPS: | Works with varying levels of staff and in direct contact with consumer/client. |
| TIME COMMITMENT: | Monday through Friday Minimum 40 work hours Full Time, Maximum 30 work hours Part Time. |
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