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CareMetx, LLC · 3 days ago

Reimbursement Specialist

United States

Full-time

Onsite

Entry Level

$30K/yr - $39K/yr

1+ years exp

CareMetx, LLC is dedicated to supporting the patient journey by providing hub services and innovative technology for pharmaceutical and medical device innovators. The Reimbursement Specialist is responsible for various reimbursement functions, including benefit investigations and prior authorization support, while ensuring effective communication with providers and payors.

BiotechnologyInformation Technology

Responsibilities

Collects and reviews all patient insurance benefit information, to the degree authorized by the SOP of the program

Provides assistance to physician office staff and patients to complete and submit all necessary insurance forms and program applications

Completes and submits all necessary insurance forms in a timely manner as required by all third party payors for prior authorizations. Tracks and follow up on prior authorization request

Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly

Maintains frequent phone contact with provider representatives, third party customer service representatives, and pharmacy staff

Reports any reimbursement trends/delays to supervisor

Processes any necessary insurance/patient correspondence

Provides all necessary documentation required to expedite prior authorization request. This includes demographic, authorization/referrals, National Provider Identification (NPI) number, and referring physicians

Coordinates with inter-departmental associates as necessary

Communicates effectively to payors 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

Reports all Adverse Events (AE) disclosed in alignment with training and Standard Operational Procedures (SOP)

Typically receives little instruction on day-to-day work, general instructions on new assignments

Other duties as assigned - Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice

Qualification

Reimbursement processesInsurance benefit knowledgeCustomer serviceMicrosoft ExcelNegotiation skillsInterpersonal skillsOrganizational skillsProblem solvingTime managementEffective communication

Required

High School, Diploma, or GED required

Previous 1+ years of experience in a specialty pharmacy, medical insurance, physician's office, healthcare setting, and/or related experience

Ability to communicate effectively both orally and in writing

Ability to build productive internal/external working relationships

Strong interpersonal skills

Strong negotiating skills

Strong organizational skills; attention to detail

General knowledge of pharmacy benefits, and medical benefits

Ability to proficiently use Microsoft Excel, Outlook and Word

Ability and initiative to work independently or as a team member

Ability to problem solve

Strong time management skills

Customer satisfaction focused

Preferred

Global understanding of commercial and government payers preferred

Company

CareMetx, LLC

CareMetx, LLC is a leading technology-enabled patient services partner, providing high-touch support to accelerate patient initiation and adherence for specialty therapies.

Founded in 2011

Bethesda, Maryland, USA

501-1000 employees