Reimbursement Specialist

Position Objective: The Reimbursement Specialist researches and investigates drug or treatment specific coverage and benefits to assist MDOs (medical doctors' offices).
Accountability: The incumbent will report to the Program Manager.
Essential Functions:

• Handles benefit request investigations submitted by MD offices. Investigations to be conducted via test claim, eBV and/ or phone.
• Contacts insurance companies directly to obtain patient's specialty pharmacy and prescription benefits.
• Updates pharmacy claim processing info i.e. BIN, PCN, ID and Group numbers in the patient record.
• Document detailed pharmacy benefit results with the appropriate information regarding patient's pharmacy benefits and network pharmacy details according to the established triage rules and procedures.
• Handling, detecting and fixing errors within the system to ensure proper benefit retrieval.
• Identify and escalate priority issues to...

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