Senior Reimbursement Specialist - Specialty Pharmacy

Job description

This role works directly with healthcare and pharmaceutical providers, as well as insurance plans/payers to gather information about a patient’s insurance and the coverage provided for a specific pharmaceutical product. You will support the healthcare providers addressing questions regarding coding and billing and navigating complex reimbursement issues. Key Responsibilities: Patient Account Management Research and update patient records with: - Full demographics - Financial and insurance information - Provider and facility details - Prescription data - Patient and provider signatures (as required) - Ensure all documentation is accurate and up to date in Salesforce. Summary of Benefits (SOB) Review: Confirm eligibility and benefits by reviewing the Benefit Investigation Report (BIR) and the SOB and determine: - Whether a manual BI was completed - If the SOB was generated using the correct template - Revise and finalize the SOB documentation. - Fax the completed SOB to the Health Care Provider’s (HCP) office and follow up, as needed. - Notate the account and complete associated tasks in Salesforce. Call Handling (Inbound/Outbound): - Verify HIPAA before proceeding (Name, DOB, ZIP, A...