Reimbursement Specialist

Description :

• The Reimbursement Specialist will be responsible for providing support and information about the insurance coverage of their prescribed medicines.
• They will accurately and efficiently find the patient's insurance coverage, and any other requirements by leveraging reimbursement tools and collaborating with payers and providers.
• The Reimbursement Specialist may also share appropriate information with Patient Specialty Services field teams. This information may cover coverage-related queries from customers, provide pre-authorizations for medical treatment, and outline information regarding co-payments.
• The Reimbursement Specialist must have strong communication skills to converse with payors and providers about benefits coverage and be able to offer solutions in accordance with approved procedures.
• A Reimbursement Specialist will possess an aptitude for learning and continual development.
• Your responsibilities will include, but are not limited to :
• Develop and maintain knowledge of PSS programs and payer coverage; broaden program knowledge over time.
• Learn and utilize protocols, information and technology to gather patient coverage information.
• Some of this will be completed via phone calls to payers in a prompt and courteous manner.
• Prepare proper documentation and notifications; perform proper escalation, tracking, and follow-up
• Evolve skills to navigate the payer landscape regarding programs over time
• As applicable, raise innovative ideas which will drive improved efficiency and effectiveness of customer service to Team Leads.
• Calling Pharmacy Benefit Managers as well as medical payers to obtain patient' benefits (i.e., confirming plan details, obtaining cost information, patient responsibility, prior authorization / appeal requirements, etc.).
• Calling the payers to follow up on the status of the coverage exceptions (PA, appeal, NFE).
• Documenting this information and sending it via fax to healthcare providers
• Will need to call out to insurance companies every day, speaking about patient coverage, confirming if they have coverage for a specialty medication, copay, deductible, etc.

Qualifications :

• High School Diploma required
• At least 6 months of proven Reimbursement Experience (such as Healthcare, Payers or Pharmaceuticals,)
• Experience and exposure in balancing multiple priorities with multiple audiences
• Experience working with data entry system(s), fax machines, computer software, and telephone technology
• Strong phone and verbal communication skills - ability to follow oral and written directions
• Good problem-solving and critical thinking skills
• Ability to interpret, capture and document the details of payer conversations, in a timely and efficient manner
• Computer literacy with email, video conferencing systems and data entry systems
• Preferred : 1 year of Reimbursement Specialist experience within a Customer Contact Center in the Pharmaceuticals industry
• Need to have experience speaking with insurance companies, working in a fast paced environment

Benefits :

Healthcare Insurance : Synectics offers eligible employees and their dependents healthcare coverage through BlueCross BlueShield of Illinois.

Eligibility begins on the 1st day of the calendar month following 60 days of continuous full time employment with Synectics.

Premiums are subsidized by Synectics.

Dental Insurance : Synectics offers eligible employees and their dependents a dental plan through MetLife. Eligibility begins on the 1st day of the calendar month following 60 days of continuous full time employment with Synectics.

Vision Insurance : Synectics offers eligible employees vision insurance through VSP. Eligibility begins on the 1st day of the calendar month following 60 days of continuous full time employment with Synectics.

401(k) Plan : The Synectics Inc. Investment Savings Retirement Plan. Synectics offers all employees who are 21 years of age or older the opportunity to invest in the 401(k) Plan on the first enrollment date that is at least 30 days after employment begins.

Enrollment dates are each January 1st, April 1st, July 1st, and October 1st.

Technical Certification Bonus : Synectics is pleased to award its employees a bonus of up to $500 for an approved professional certification.

In determining the bonus amount, Synectics will consider the cost of the test(s) for any certification relating to your current position, achieved during your employment with us.

Only one Certification Bonus per calendar year may be awarded per employee. Only current, active employees will be eligible to receive this bonus.

It will be awarded 90 days after the Synectics office has received documentation confirming the successful completion of the certification.

Synectics is an equal opportunity employer.