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Reimbursement Specialist I
Ref No.: 17-15048
Location: South San Francisco, California
Job Title: Reimbursement Specialist I
Job Company: Major BioPharma
Job Location: SSF, CA 94080
Job Duration: 6+ months contract
Job Schedule: Candidates must have open availability from 5AM - 5PM depending upon business needs.

Job Description:
  • Investigates patient's insurance benefits.
  • Identifies network providers, provider restrictions, co-pays as needed.
  • Documents requirements for prior authorization and medical review process.
  • Documents activities appropriately in progress notes.
  • Pursue product coverage for patients in accordance with the payor's authorization requirements within the department's established performance criteria.
  • Create written communication to customers regarding reimbursement status.
  • Maintains payor profiles by recording payor specific data promptly into the system. Consults with team members on an as needed basis.
  • Collects and enters data for distributor referral cases.

Desired Skills:
  • 4 years experience in Healthcare reimbursement required; verifying benefits, prior authorizations and working with public and private insurance.
  • Must be able to drive for results.
  • Proficient in all aspects of reimbursement (i.e. benefit investigation, pay reimbursement policies).
  • Excellent investigational and analytical skills with a proven ability to communicate effectively in both written and verbal format.
  • Ability to work collaboratively in a team structure and responsibly delegates next steps to appropriate team members.
  • Demonstrates effective problem solving and excellent customer service.
  • Exceptional attention to detail and ability to prioritize tasks.
  • Requires computers skills including MS Excel.

1) Medical Insurance payer knowledge - demonstrated in phrases: Benefit investigations/ verifications, prior authorizations, Insurance networks, Specialty Pharmacies, Pharmacy Benefit managers, Major Medical.
2) 2+ years experience verifying medical benefits.
3) Evidence of experience verifying benefits with Private payers (Healthcare, Client/Shield, Well Point, etc.).
4) Evidence of experience working with Public payers (Medicare & Medicaid must be listed in resume).
5) Proficient computer skills.
6) Work in team environment.

1) Experience with Medicare Part B & Medicare Part D specifically listed on resume.
2) Work at a reimbursement service company (Lash, Covance, McKesson, Health Connections, etc.).
3) Evidence of thorough knowledge of the public & private payer landscapes.
4) Work at or with a specialty pharmacy (Caremark, CuraScript, Option Care, Healthcare SP, etc.).

A BA/BS degree is preferred and NOT required.