Reimbursement Specialist

Description:

The Reimbursement Specialist assumes responsibility for managing reimbursement related issues for patients requiring specialty medications. This role will act as the patient advocate and work closely with patients to navigate and secure potential sources of reimbursement. Together with the pharmacy services, this role will bring more convenience, lower spend, and better health outcomes to patients.

ESSENTIAL FUNCTIONS:
 

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• • Determine operational processes, and lead internal and external teams in implementation of program launch and ongoing utilization through assigned and self-initiated “pull through” efforts.
  • rive continual process improvements to enhance work efficiencies and optimize member experience. Provide training to internal team members as required.
  • anage case-by-case reimbursement for patients requiring specialty medications. Gather all pertinent information, coordinate patient cases, manage applications and work directly with the private, public, or manufacturer-sponsored drug funding programs to optimize reimbursement.
  • ommunicate and educate patients regarding their private drug coverage and options, including status of Prior Authorization requests.
  • dentify and resolve reimbursement issues to facilitate pharmacy processes including prescription processing and invoicing.
  • dentify gaps and opportunities for clinical education and healthcare support, and liaise with the appropriate internal teams or external organizations to provide and enhance patient care.
  • aintain and manage standard operating procedures and specialty medication funding program database.
  • evelop and maintain relationships with private/public payers, manufacturers and plan sponsors. Apply knowledge and insights to enhance Specialty Pharmacy service offerings.



 
• QUALIFICATIONS:
   

   

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  • • Bachelor’s Degree preferred
    • -5 years of experience in the pharmacy benefit management, insurance, pharmacy, biotechnology, or pharmaceutical industries; customer service and/or reimbursement.
    • emonstrated commitment to improve patient care
    • ble to work independently and within a team
    • xcellent written/verbal communication to include providing clear instructions
    • bility to multitask
    • trong problem-solving skills with the ability to resolve issues effectively and efficiently
    • nowledge of the private or public drug reimbursement would be an asset
    • nowledge of pharmacy dispensing software is preferred.
    • omputer proficiency in MS Office applications, with database experience a plus.
    • ilingual is an asset.