Reimbursement Specialist

• Serve as a subject-matter expert on reimbursement, access, and coverage issues
• Educate healthcare providers, office staff, and practice managers on insurance, reimbursement, coding, billing, formulary, prior authorization, and appeals processes
• Support patient access to client products by resolving reimbursement and coverage challenges
• Act as a liaison between providers, manufacturers, pharmacies, and payers
• Collaborate with patient assistance and reimbursement support services
• Inform office staff about coverage and payer policy changes within assigned territories
• Probe office processes and identify root causes of access or reimbursement issues
• Deliver interactive educational presentations at provider sites of service
• Provide client-approved reimbursement information regarding client products
• Travel weekly to healthcare offices, including potential overnight stays
• Perform other related duties as assigned

Field Reimbursement Specialist helping Cencora patients access specialty medications

Field Reimbursement Specialist

Field Reimbursement Specialist helping Cencora patients access specialty medications. Educating healthcare offices and resolving pharmacy benefit, coverage, and reimbursement barriers across a multistate territory.

• Responsibilities include patient account follow up on all types of hospital claims.
• This includes following accounts through secondary and subsequent payers.
• Must have thorough knowledge of hospital managed care contracts, standard collection processes and state and federal regulations.
• An understanding of medical terminology and diagnosis and procedure coding is needed.
• Review all accounts with payments previous day.
• Review and resolve reminder queue daily.
• File secondary, tertiary, etc. paper claims as needed.
• Maintains established policies and procedures, objectives, quality assurance programs and safety standards.
• Participates in educational programs and in-services.
• Provide customer service for patients, internal customers and insurance companies as needed.
• Performs other duties as assigned.

Reimbursement Specialist managing hospital claims in DFW area

Reimbursement Specialist managing patient account follow up on hospital claims. Requires understanding of hospital contracts and payer rules in DFW area with remote work option.

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Field Reimbursement Specialist

Reimbursement Specialist