Reimbursement Specialist

Job Description The Position The Reimbursement Specialist is primarily responsible for interfacing with Patients, HCPs, and Payers by providing reimbursement support for activities related to benefit coverage, prior authorization, claim denials, appeals, triage to third party support centers, and general inquiry. Essential Duties and Responsibilities Provide dedicated and personalized support delivered over the phone, CRM, and email. Complete investigations and answer questions regarding insurance benefits, including information about coverage and out‑of‑pocket costs. Assist with prior authorization and medical necessity processes, benefit verification and assistance in a manner that is consistent with industry best practice. Determine when the call reason is best handled by a third‑party support center and triage accordingly. Maintain a positive attitude and a helpful approach to customers and clients. Conduct enrollment intake for all incoming inquiries. Participate in continuous quality improvements and training opportunities. All other duties as assigned. Expectations of the Job Assist callers with benefit verifications and providing support related to coverage, out‑of‑pocket costs and prior authorizations as needed. Triage to appropriate third‑party support centers. Focus on results in a professional, ethical, and responsible manner when dealing with patients, caregivers, customers, vendors, team members, and others. Accept accountability and responsibility in work practices and expectations; deliver what is promised. Foster a collaborative, team‑oriented attitude and communicate effectively with others with clarity and transparency. Use innovative critical and creative thinking to evaluate and solve work and customer issues. Seek assistance in solving work problems through collaboration and information seeking. Learn, understand and follow all company and client policies and procedures. Maintain excellent attendance. Must be able to work rotating 8‑hour shifts Monday through Friday. Minimum Knowledge, Skills, and Abilities Strong pharmacy reimbursement experience, especially understanding of prior authorization process. Experience conducting benefit verifications with payers, preferably supporting retail prescription drug products. Knowledge of healthcare administration and specifically healthcare billing and reimbursement procedures and regulations. Knowledge of retail pharmacy operations preferred. Excellent oral, written, and interpersonal communication skills. Ability to multitask. Positive attitude. Accurate and detail‑oriented. Ability to work independently and function as a team player. Ability to work in a fast‑paced, metric‑driven environment while remaining patient‑minded. Strong computer skills with a working knowledge of Microsoft Word, Excel, and PowerPoint. Preferred Qualifications Customer service and/or contact center experience. Reimbursement/Patient Services experience. Physical and Mental Demands and Working Environment The physical and mental requirements and work environment are representative of those an individual encounters while performing the essential functions of this position. The employee is frequently required to reach, grasp, stand, and/or sit for long periods of time (up to 90% of the shift), walk, talk, and hear; occasionally required to lift and/or move up to 25 pounds. The noise level in the work environment is usually moderately quiet, with frequent interruptions and multiple demands. Employment Practices We are an Equal Opportunity Employer. Consistent with the Americans with Disabilities Act (ADA) and applicable state and local laws, we provide reasonable accommodations when requested by a qualified applicant or candidate with a disability, unless such accommodation would cause an undue hardship. The policy regarding requests for reasonable accommodations applies to all aspects of the hiring process. #J-18808-Ljbffr