Healthcare Customer Care Specialist

Location: Chesapeake, Virginia
Posted On: 10/6/2017
Job Code: 2522_BRD_Chesapeake,
Job Description
• The Reimbursement Specialist strives to eliminate barriers to reimbursement and access in patients with complex and rare medical conditions.
• The Reimbursement Specialist, reporting to the Program Manager or Program Supervisor, navigates patient’s healthcare insurance, performs administrative functions and interacts with key stakeholders in a call-center environment.
• Reimbursement specialists require personal integrity, strong empathy, a high level of accuracy and superb attention to detail.

• (Duties may include, but not limited to all or some of the following)
• Accurately interprets patient insurance, prescription and other health-related documentation
• Conducts medical and pharmacy benefit insurance verifications and investigations for commercial and government payors
• Communicates with insurance companies, patients, providers and prescribers to coordinate reimbursement and access solution
• Researches available alternative funding options to reduce patient’s financial burden
• Handles high call volumes in a call-center environment
• Communicates with internal and external departments to facilitate coordination of care
• Reports Adverse Events (AE) and Product Quality Complaints (PQC), as required and as per policy
• Strictly adheres to Standard Operating Procedures (SOPs)
• calls
• Analyzes records to transcribe appropriate ICD-9, ICD-10, CPT, HCPCS codes
• Validates and enters prescription orders
• Completes casework in a timely manner with consistent follow-up as the accountable case manager
• Maintains patient confidentiality
• Advocates on behalf of the patient to problem-solve reimbursement and access issues
• Understands prescription drug benefit management techniques including Formularies, Prior Authorizations, etc.
• Performs clerical and administrative functions such as mailing and faxing correspondence, data entry, scheduling, etc.
• Validate licensed practitioners
Category:Non-IT  code:new
Job Requirements
• Required: Associates degree or equivalent work experience is required
• 2 - 3 years in pharmacy, managed care, Medicaid and/or Medicare organizations, pharmaceutical and/or biotech manufacturer, medical office, or related similar field
• Preferred: 1+ years within Specialty Medical Practice – ie. GI, infusion, oncology, eye care
• Bachelor’s degree

• Prior experience with scheduling patients
• Knowledge of Medical Terminology
• Working knowledge or experience with resolving drug reimbursement issues
• Knowledge of HCPCS, CPT and ICD-9/10 billing and/or coding
• Certification as Pharmacy Technician is plus
• Knowledge of US private and government payors
• Working knowledge of Office (Word, Excel, Outlook)

• Required: Customer focused
• Fast and accurate data entry
• Clear, pleasant speaking voice
• Excellent communication skills (oral and written)
• Ability to handle multiple tasks and troubleshoot issues
• Ability to work with little or no supervision
• Ability to adapt quickly to changing environment
• Team player/consensus builder
• Ability to interact with a diverse group
• Project management skills
• Ability to calculate figures such as discounts and percentages

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Contact Details
Manan Patel
E-mail Address