Patients First. Powered by Evidence.
Senior Reimbursement Specialist
Location
United States
Posted
11 days ago
Salary
0
Seniority
Senior
Job Description
Senior Reimbursement Specialist
UBC
• Provide high quality customer service • Effectively interface with patients, patient’s families, national payers, home cares and medical doctor’s offices • Conduct benefit investigations, verify insurance benefits for patient and physicians’ offices • Submit and obtain prior authorizations as required by payer • Obtain recertification for cases requiring extended treatment/coverage beyond the expiration of original approval • Accurately enter and maintain data as required in client database and patient files • Utilize the client database to monitor outstanding items on each client case file • Ensure files are complete so team can determine the current status • Participate in conference calls as needed with Client Sales Representatives, client management and physicians’ offices regarding status of cases • Provide coordination of order for product, shipment of product, and therapy initiation with pharmacy and patient • Participate in Call Center Activities, triage and respond to incoming calls from patients, insurance companies, physicians, Sales Reps, pharmacies and homecare agencies • Educate patients, prescribers, and others regarding program requirements, and facilitate referrals • Maintain good housekeeping techniques, adhering to quality and production standards and comply with all applicable company, state, and federal safety and environmental programs and procedures
Job Requirements
- High School Diploma/GED or equivalent experience
- 4 – 6 years’ experience in the insurance, biotechnology, or pharmaceutical industries; customer service and/or reimbursement.
- Health Insurance claims or patient accounting experience a plus.
- Computer proficiency in MS Office applications, with database experience a plus.
- Excellent written and verbal communication skills, with demonstrated ability to communicate with others at all levels.
- Ability to manage multiple priorities and meet deadlines.
- Detail oriented with good analytical skills.
- Knowledge of third party billing, coding, medical terminology, prior authorizations and appeals preferred.
- Ability to travel as required - This is primarily a remote position; however, occasional travel may be required based on client, business, or training needs.
Benefits
- Remote opportunities
- Competitive salaries
- Growth opportunities for promotion
- 401K with company match*
- Tuition reimbursement
- Flexible work environment
- 20 days PTO
- Employee assistance programs
- Medical, Dental, and vision coverage
- HSA/FSA
- Telemedicine (Virtual doctor appointments)
- Wellness program
- Adoption assistance
- Short term disability
- Long term disability
- Life insurance
- Discount programs
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• Bristol Hospice is a nationwide industry leader committed to providing a family-centered approach in the delivery of hospice services throughout our communities. • We are dedicated to our mission that all patients and families entrusted to our care will be treated with the highest level of compassion, respect, and dignity.
• Assure all insurance claims are processed timely, accurately, and efficiently • Secure payments from both contracted and non-contracted insurance entities as well as customers • Work closely with Customer Sales Support to assure data accuracy and communication of requirements from health insurance plans • Review medical criteria to assure patient documentation meets standards • Carefully review all patient related data and documentation for accuracy prior to claim submission • Create and submit healthcare claims to insurance companies • Communicate with patients to advise on status of insurance claims, as necessary • Contact patients regarding collection of outstanding invoices • Field inbound calls from patients regarding inquiries related to insurance claims • Make outbound investigational calls to insurance providers to determine status of outstanding claims • Negotiate structured payment plans • Access CRM to receive and provide up to date patient claim information • Keep up to date with specifications on all of Tandem products and services • Confirm completion of required training plan before assuming job responsibilities • Ensure work is performed in compliance with company policies including Privacy/HIPAA and other regulatory, legal, and safety requirements


