CareMetx, LLC · 9 hours ago
Reimbursement Specialist
United States
Full-time
Onsite
Entry Level
1+ years expCareMetx, LLC is dedicated to delivering industry-leading patient access solutions and support services. The Reimbursement Specialist is responsible for various reimbursement functions, including benefit investigations, prior authorization support, and responding to provider account inquiries.
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)
Maintain regular and reliable attendance, including being present, on time, and prepared for work as scheduled
Performs other related duties as assigned
Qualification
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
Maintain regular and reliable attendance, including being present, on time, and prepared for work as scheduled
Must be flexible on schedule and hours
Overtime may be required from time to time
Must be willing to work weekends if required to meet company demands
Preferred
Global understanding of commercial and government payers
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.
501-1000 employees
Funding
Current Stage
Late StageTotal Funding
unknown2021-01-14Acquired
Leadership Team
Jim Rowe
President and CEO
Kurt Brumme
Chief Financial Officer
Recent News
2025-10-21
2025-09-19
2025-06-04
Company data provided by crunchbase