SR Case Reimbursement Specialist

Description:

Insurance Reimbursement Specialists are primarily responsible for working with insurance companies and medical billing staff to manage the billing/reimbursement process.

Under the general direction of the Operations Leadership, the Case

Care Educator will serve as the primary point of contact with the HCP, Patient,

and client’s field reimbursement team leaders. The Case Care Educator will

use effective listening and communication skills to support patients,

prescribers, and all clinic staff via phone and other support channels (email,

SMS, etc.) to provide exquisite service and support. The Case Care Educator

will be responsible for speaking with providers and patients about Reimbursement

Services including but not limited to Benefit Verifications, Prior

Authorization, Appeals, Financial Support Services including but not limited to

PAP, Copay support, independent foundation assistance, Adherence support, as

well all other program services.

Care educators will conduct monthly adherence calls and build

relationships with patients to get ahead of any product access challenges and

educate on the importance of maintaining therapy as prescribed by their

provider. Care educators are responsible for maintaining an account enterprise

view to ensure that provider and patient preferences for communication are met

with the highest level of service.

Skills:

reimbursement, medical terminology, benefit verification, prior authorization, insurance billing, medical billing, medical claims processing, Insurance, coordination of benefits, health insurance, express scripts, claim, cvs, medical, insurance claim, pharmacy, bene, Phone support, provider calls, insurance coverage, medical insurance, benefits administration, insurance companies

Additional Skills & Qualifications:

• High School, Diploma, or GED required
• 5 + years’ experience with specialty providers in support of reimbursement and/or reimbursement hubs or 5+ years’ experience with clinical and practice management.
• Prior experience as a COA – certified ophthalmic assistant, COT – certified ophthalmic technician, or COMT – certified ophthalmic medical technician is given preference.
• Remote designated work space
• M-F 8am-8pm EST- Must be open for all shifts during this time