Reimbursement Specialist Resume Samples

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RT
R Thiel
Reilly
Thiel
70335 Deckow Mountains
Houston
TX
+1 (555) 673 6731
70335 Deckow Mountains
Houston
TX
Phone
p +1 (555) 673 6731
Experience Experience
New York, NY
Reimbursement Specialist
New York, NY
Mueller-Medhurst
New York, NY
Reimbursement Specialist
  • Performs error analysis for disputed/denied claims and provides recommendations for process improvements. Assists with third party audits when necessary
  • Maintains frequent phone contact with provider representatives, third party customer service representatives, pharmacy staff, and case managers
  • Provides assistance to physician office staff and patients to complete and submit all necessary insurance forms and program applications
  • Update registration information, post denial codes and adjustments in practice management systems
  • Analyze weekly denial reports to spot trends; assess opportunities to improve internal workflows
  • Performs related duties as assigned
  • Assist team in assuring phone and order entry coverage
Chicago, IL
Field Reimbursement Specialist
Chicago, IL
Kunze, Mante and Olson
Chicago, IL
Field Reimbursement Specialist
  • Reimbursement (coding, coverage any payment policy) expertise on manufacturer products in all places of service (POS) under both medical and pharmacy benefit designs
  • Frequent interactions with key stake holders in multiple sites of care including: physician practices, ambulatory surgical centers, hospital out-patient departments and other related facilities
  •  Establish relationships within a practice by working closely with them to help remove access barriers to specialty products for their patients
  •  Educate physician office staff on the use of our client's patient assistance and call center support services, including web-based provider programs
  • Review patient-specific information in cases where the site has specifically requested the assistance in resolving any issues or coverage challenges
  •  Review patient-specific information in cases where the site has specifically requested assistance in resolving any issues withcoverage challenges
  • Provide education on the product services to support patient access to therapy
present
San Francisco, CA
Senior Reimbursement Specialist
San Francisco, CA
Hettinger, Dicki and Lehner
present
San Francisco, CA
Senior Reimbursement Specialist
present
  • Assist in the measurement of performance against standards
  • Case workers / Case managers
  • Understands prescription drug benefit management techniques including Formularies, Prior Authorizations, etc
  • Performs clerical and administrative functions such as mailing and faxing correspondence, data entry, scheduling, etc
  • Working knowledge of Microsoft Office (Word, Excel, Outlook)
  • Perform extensive reimbursement counseling, including: private and government insurance investigation, advocacy counseling, research alternative payment options (third party payers), insurance and medical coding (ICD9, J coding)
  • Opportunity to work with leading Pharmaceutical clients
Education Education
Bachelor’s Degree in Healthcare Administration
Bachelor’s Degree in Healthcare Administration
North Carolina State University
Bachelor’s Degree in Healthcare Administration
Skills Skills
  • Ability to adapt quickly to changing environment
  • Ability to proficiently use Microsoft Excel, Outlook and Word
  • Strong organizational skills; attention to detail
  • Demonstrated knowledge and proficiency in the principles, procedures and best practices related to this position
  • Proficient level of software proficiency in using PC software to support activities, especially Microsoft Office
  • Strong attention to detail
  • Ability to calculate drug dispensed based on prescription/order correctly
  • Ability to work with little or no supervision
  • Ability to interact with a diverse group
  • Ability to handle multiple tasks and troubleshoot issues
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15 Reimbursement Specialist resume templates

1

Documentation & Reimbursement Specialist Resume Examples & Samples

  • Investigates, responds to and communicates information regarding complex coding, documentation, compliance and/or reimbursement matters. Analyzes coding and/or documentation issues/questions from both a compliance and reimbursement perspective. Performs research and provides recommendations for use of codes and/or documentation in a timely manner. Works closely with hospital administrators and faculty as appropriate
  • Assists with tracking recommendations for improvement and re-bills related compliance monitoring. Provides additional monitoring as needed
  • Promotes appropriate clinical documentation. Reviews medical records and identifies potential gaps in clinical documentation. Assists with management of Helpline questions
  • Develops, plans and conducts comprehensive coding and/or documentation training for a highly regulated healthcare process based on training needs of employees. Provides coding and/or documentation expertise for all compliance and reimbursement issues
  • Performs chart reviews for professional fees and/or outpatient and inpatient services billed through IDX and/or the hospital billing systems. Analyzes results and prepare formal reports with findings and recommendations. Facilitates and improves hospital staffs’ and/or physicians’ understanding of payor and regulatory requirements by providing feedback related to documentation information
2

Reimbursement Specialist Resume Examples & Samples

  • 2 - 3 years in customer service, pharmaceutical, medical, insurance, call center, or related similar field
  • Preferred
  • 1+ years within Specialty Medical Practice – ie. GI, infusion, oncology, eye care, Pharmacy Tech background highly desirable
  • Strong knowledge of insurance investigations
  • Strong knowledge of government and private insurance
  • CPT & ICD9 coding experience or certification
  • Experience with J codes
  • Buy and bill background
  • Prior experience with scheduling patients
  • Customer focused
  • Fast and accurate data entry
  • Clear, pleasant speaking voice
  • Excellent communication skills (oral and written)
  • Ability to handle multiple tasks and troubleshoot issues
  • Ability to work with little or no supervision
  • Ability to adapt quickly to changing environment
  • Team player/consensus builder
  • Ability to interact with a diverse group
  • Project management skills
  • Able to work a rotational shift between the hours of 7:45am and 8:15pm – Mon to Fri
3

Ubc-field Reimbursement Specialist Resume Examples & Samples

  • Education and support to targeted accounts and HCPs on manufacturers support programs and available patient access services
  • Assistance to key accounts to help overcomes access barriers for key client stakeholders
  • Professional representation of manufacturer’s patient and physician access services
  • Developing and executing geographical strategic and tactical plans to meet customer and business needs
  • Bachelor’s Degree required; degree in Business or Healthcare related
4

Reimbursement Specialist Resume Examples & Samples

  • Manage assigned accounts, ensuring that all 90+ day AR are paid on time, which includes resolving issues as needed
  • Perform filing duties accurately and timely
  • Respond to correspondence
  • Generate reports from CPR+ or other report generation software
  • Complete miscellaneous clerical duties
  • Investigate complaints
  • Respond to customer questions timely and accurately
  • Professionalism and tact
  • Negotiation
  • Business Relationship Building: customer service orientation, respectful speaking manner, conveyance of empathy, effective listening, relation to all staff levels
  • Team-oriented, dependable
  • Problem-solving: solutions oriented, clear communication, communicates a sense of authority through subject matter expertise, resourcefulness
  • Troubleshooting: ability to anticipate issues, research and implement creative solutions
  • Knowledge of claim and benefit requirements for Medicare, Medicaid, HMO, PPO and/or other third party payors
  • Ability to calculate drug dispensed based on prescription/order correctly
  • Ability to calculate figures and amounts correctly, such as interest and percentages
  • Ability to investigate issues with invoices and confer with internal and external parties to resolve discrepancies
  • Education of drug types and treatments, so as to resolve issues effectively while maintaining business relationships
  • Clear, effective oral Communication of the American English language, both face-to-face and telephone
  • Adherence to deadlines
  • Minimum of 5 years hands-on experience in a billing or collections role within a physician office, specialty infusion, home care or related field required
5

Field Reimbursement Specialist Resume Examples & Samples

  • Develop relationships with patient access stakeholders including office management, institution administrators, billing and coding staff, nurses, and other individuals to deliver information that facilitates patient access to and appropriate reimbursement of Takeda products
  • Navigate specialty product access and reimbursement landscape at a Regional, Customer and Patient level to optimize access appropriately for Takeda specialty products
  • Develop and execute local market based initiatives that will educate access stakeholders within key accounts on the value and process of Takeda’s reimbursement, support and education services
  • Be responsible for understanding and upholding Takeda Legal and Compliance guidance at a customer and field leadership level in terms of access, cost and reimbursement related issues
  • Minimum 3 years relevant experience including similar reimbursement roles within pharmaceutical or biotech or account based reimbursement management
  • Demonstrated knowledge of the complex regulatory environment
6

Field Reimbursement Specialist Resume Examples & Samples

  • Billing and claims systems knowledge for all provider types and places of service (POS)
  • Educate and support targeted accounts and HCPs on manufacturers support programs and available patient access services
  • Assist key accounts to overcome access barriers for key client stakeholders
  • Support a positive impact on the patient journey and the brand experience
  • Develop and execute geographical strategic and tactical plans to meet customer and business needs
  • Frequent interactions with key stake holders in multiple sites of care including: physician practices, ambulatory surgical centers, hospital out-patient departments and other related facilities
  • Provide information on relevant access topics related to client’s products
  • Review patient-specific information in cases where the site has specifically requested the assistance in resolving any issues or coverage challenges
  • Provide feedback to internal manufacturer teams on local payer trends and access issues
  • The FRS must understand billing and claims systems for provider offices and related facilities, including all places of service (POS). This also include understanding coding, coverage and payment policies and how these elements impact patient access to appropriate medical care
  • The FRS must have clinical understanding of client products sufficient to support any medical necessity position for accurate claims
  • Bachelor’s degree required, Health management degree preferred
  • Nursing degree a plus
  • Coding and billing background required
  • Retail, hospital and specialty distribution required
  • Hospital, ASC and surgical place of service experience required
  • Oral, injectables, medical device and surgical product management
  • HUB engagement
7

Field Reimbursement Specialist Resume Examples & Samples

  •  Establish relationships within a practice by working closely with them to help remove access barriers to specialty products for their patients
  •  Offer assistance and support the entire access journey through payer prior authorization to appeals/denials requirements procedures and forms
  •  Review patient insurance benefit options
  •  Identify alternate funding/financial assistance programs
  •  Coordinate with our client's Patient Support Services Program's representatives
  •  Educate physician office staff on the use of our client's patient assistance and call center support services, including web-based provider programs
  •  Ability to travel and cover large multistate geography territories, 50% travel required, and a valid driver's license to drive to assigned healthcare accounts, unless otherwise specified
  •  The drive for self-development, the ability to collaborate and an action-oriented work ethic
8

Senior Reimbursement Specialist Resume Examples & Samples

  • Associates degree or equivalent work experience is required
  • 3 - 5 years in pharmacy, managed care, Medicaid and/or Medicare organizations, pharmaceutical and/or biotech manufacturer, medical office, or related similar field
  • Social workers/Case workers/Case managers
  • Patient Advocates
  • Specialty pharmacy or retail pharmacy background
  • Buy and bill background
  • Prior experience with scheduling patients
  • Knowledge of Medical Terminology
  • Working knowledge or experience with resolving drug reimbursement issues
  • Knowledge of HCPCS, CPT and ICD-9/10 billing and/or coding
  • Certification as Pharmacy Technician is plus
  • Knowledge of US private and government payors
  • Microsoft Office skills (Word, Excel, Outlook)
  • Empathy and curiosity
  • Problem Solving and swift investigation
  • Initiative
  • Analytical with elaborate thinking
  • Effective Listening
  • Excellent Communication Skills (oral and written)
  • Use of / Access to Resources
  • Bi-lingual (English / Spanish - Native)
  • Ability to Present and Facilitate
  • Customer focused
  • Fast and accurate data entry
  • Clear, pleasant speaking voice
  • Ability to handle multiple tasks and troubleshoot issues
  • Ability to work with little or no supervision
  • Ability to adapt quickly to changing environment
  • Team player/consensus builder
  • Ability to interact with a diverse group
  • Project management skills
  • Ability to calculate figures such as discounts and percentages
  • Must be flexible to work a rotational shift between the hours of 8am to 8pm (Mon to Fri)
9

Reimbursement Specialist Resume Examples & Samples

  • Manage assigned accounts, ensuring Accounts Receivables are resolved within 90 days, which includes resolving issues as needed
  • Problem-solving: solutions/results oriented, clear communication, communicates a sense of authority through subject matter expertise, resourcefulness
  • 3+ years of experience in medical billing, accounts receivable, intake or Bachelor's degree in Healthcare Administration or business-related field
10

N Reimbursement Specialist Resume Examples & Samples

  •  Establish relationships within a practice by working closely with them to help remove access barriers to specialty products for their patients
  •  Act as an extension of Prolia Plus and provide live one-on-one coverage support
  •  Offer assistance and support the entire access journey through payer prior authorization to appeals/denials requirements procedures and forms
  •  Review patient-specific information in cases where the site has specifically requested assistance in resolving any issues withcoverage challenges
  •  Review patient insurance benefit options
  •  Identify alternate funding/financial assistance programs
  •  Coordinate with our client's Patient Support Services Program's representatives
  •  Educate physician office staff on the use of our client's patient assistance and call center support services, including web-based provider programs
  •  Provide information on relevant access topics related to our client's products
  •  Serve as payer expert for defined geography and communicate changes to key stakeholders
  •  Provide office support in accurate coding and billing for Amgen products
  •  A Bachelor's Degree, relevant specific practice management experience preferred
  •  Minimum two years' experience in public or private third party access arena or pharmaceutical industry in managed care, clinical support, and/or sales Experience with specialty products (preferably buy and bill) acquired through Specialty Pharmacy networks and the ability to teach an office the entire process from script to injection
  •  Experience with coding, billing and in-office support of these programs
  •  Knowledge of Centers of Medicare & Medicaid Services (CMS) policies and processes with expertise in Medicare Part D (Pharmacy Benefit design and coverage policy) a plus
  •  Previous experience in launching new specialty pharmaceutical/biologics products or indications a plus
  •  Ability to travel and cover large multistate geography territories, 50% travel required, and a valid driver's license to drive to assigned healthcare accounts, unless otherwise specified
  •  The drive for self-development, the ability to collaborate and an action-oriented work ethic
11

Reimbursement Specialist Resume Examples & Samples

  •  Establish relationships within a practice by working closely with them to help remove access barriers to specialty products for their patients
  •  Act as an extension of Prolia Plus and provide live one-on-one coverage support
  •  Offer assistance and support the entire access journey through payer prior authorization to appeals/denials requirements procedures and forms
  •  Review patient-specific information in cases where the site has specifically requested assistance in resolving any issues withcoverage challenges
  •  Review patient insurance benefit options
  •  Identify alternate funding/financial assistance programs
  •  Coordinate with our client's Patient Support Services Program's representatives
  •  Educate physician office staff on the use of our client's patient assistance and call center support services, including web-based provider programs
  •  Provide information on relevant access topics related to our client's products
  •  Serve as payer expert for defined geography and communicate changes to key stakeholders
  •  Provide office support in accurate coding and billing for Amgen products
  •  A Bachelor's Degree, relevant specific practice management experience preferred
  •  Minimum two years' experience in public or private third party access arena or pharmaceutical industry in managed care, clinical support, and/or sales Experience with specialty products (preferably buy and bill) acquired through Specialty Pharmacy networks and the ability to teach an office the entire process from script to injection
  •  Experience with coding, billing and in-office support of these programs
  •  Knowledge of Centers of Medicare & Medicaid Services (CMS) policies and processes with expertise in Medicare Part D (Pharmacy Benefit design and coverage policy) a plus
  •  Previous experience in launching new specialty pharmaceutical/biologics products or indications a plus
  •  Ability to travel and cover large multistate geography territories, 50% travel required, and a valid driver's license to drive to assigned healthcare accounts, unless otherwise specified
  •  The drive for self-development, the ability to collaborate and an action-oriented work ethic
12

Orange County / Reimbursement Specialist Resume Examples & Samples

  •  Establish relationships within a practice by working closely with them to help remove access barriers to specialty products for their patients
  •  Act as an extension of Prolia Plus and provide live one-on-one coverage support
  •  Offer assistance and support the entire access journey through payer prior authorization to appeals/denials requirements procedures and forms
  •  Review patient-specific information in cases where the site has specifically requested assistance in resolving any issues withcoverage challenges
  •  Review patient insurance benefit options
  •  Identify alternate funding/financial assistance programs
  •  Coordinate with our client's Patient Support Services Program's representatives
  •  Educate physician office staff on the use of our client's patient assistance and call center support services, including web-based provider programs
  •  Provide information on relevant access topics related to our client's products
  •  Serve as payer expert for defined geography and communicate changes to key stakeholders
  •  Provide office support in accurate coding and billing for Amgen products
  •  A Bachelor's Degree, relevant specific practice management experience preferred
  •  Minimum two years' experience in public or private third party access arena or pharmaceutical industry in managed care, clinical support, and/or sales Experience with specialty products (preferably buy and bill) acquired through Specialty Pharmacy networks and the ability to teach an office the entire process from script to injection
  •  Experience with coding, billing and in-office support of these programs
  •  Knowledge of Centers of Medicare & Medicaid Services (CMS) policies and processes with expertise in Medicare Part D (Pharmacy Benefit design and coverage policy) a plus
  •  Previous experience in launching new specialty pharmaceutical/biologics products or indications a plus
  •  Ability to travel and cover large multistate geography territories, 50% travel required, and a valid driver's license to drive to assigned healthcare accounts, unless otherwise specified
  •  The drive for self-development, the ability to collaborate and an action-oriented work ethic
13

Field Reimbursement Specialist Resume Examples & Samples

  • Reimbursement expertise on manufacturer products under both medical and pharmacy benefit designs
  • Collaboration with manufacturer's internal teams to ensure alignment
  • A positive impact on the patient journey and the brand experience
  • Providing education on the product services to support patient access to therapy
  • Frequent Interactions with key stake holders in multiple sites of
  • Minimum of 4 years of healthcare related reimbursement experience; Nephrology experience greatly preferred
  • Project management or account management experience a plus
  • Experience in the healthcare industry including, but not limited to
14

Austin / Reimbursement Specialist Resume Examples & Samples

  •  Establish relationships within a practice by working closely with them to help remove access barriers to specialty products for their patients
  •  Act as an extension of Prolia Plus and provide live one-on-one coverage support
  •  Offer assistance and support the entire access journey through payer prior authorization to appeals/denials requirements procedures and forms
  •  Review patient-specific information in cases where the site has specifically requested assistance in resolving any issues withcoverage challenges
  •  Review patient insurance benefit options
  •  Identify alternate funding/financial assistance programs
  •  Coordinate with our client's Patient Support Services Program's representatives
  •  Educate physician office staff on the use of our client's patient assistance and call center support services, including web-based provider programs
  •  Provide information on relevant access topics related to our client's products
  •  Serve as payer expert for defined geography and communicate changes to key stakeholders
  •  Provide office support in accurate coding and billing for Amgen products
  •  A Bachelor's Degree, relevant specific practice management experience preferred
  •  Minimum two years' experience in public or private third party access arena or pharmaceutical industry in managed care, clinical support, and/or sales Experience with specialty products (preferably buy and bill) acquired through Specialty Pharmacy networks and the ability to teach an office the entire process from script to injection
  •  Experience with coding, billing and in-office support of these programs
  •  Knowledge of Centers of Medicare & Medicaid Services (CMS) policies and processes with expertise in Medicare Part D (Pharmacy Benefit design and coverage policy) a plus
  •  Previous experience in launching new specialty pharmaceutical/biologics products or indications a plus
  •  Ability to travel and cover large multistate geography territories, 50% travel required, and a valid driver's license to drive to assigned healthcare accounts, unless otherwise specified
  •  The drive for self-development, the ability to collaborate and an action-oriented work ethic
15

Senior Reimbursement Specialist Resume Examples & Samples

  • Duties may include, but not limited to all or some of the following
  • Handle inbound/outbound reimbursement and PAP calls
  • Perform extensive reimbursement counseling, including: private and government insurance investigation, advocacy counseling, research alternative payment options (third party payers), insurance and medical coding (ICD9, J coding)
  • Perform Patient scheduling
  • Assist with forms acquisition and completion
  • Assist team in assuring phone and order entry coverage
  • Print, mail and/or fax program correspondence
  • Validate licensed practitioners
  • Review applications
  • Data enter applications for approval, denial or rejection
  • Meet department data entry standards
  • Assist in the measurement of performance against standards
  • Meet department Reimbursement Specialist standards
  • Troubleshoot internal process, PAP caller, and customer issues
  • Administer cost share program, if applicable
  • 2 - 3 years in customer service, pharmaceutical, medical, insurance, call center, or related similar field
  • Preferred
  • 1+ years within Specialty Medical Practice – ie. GI, infusion, oncology, eye care, Pharmacy Tech background highly desirable
  • Strong knowledge of insurance investigations
  • Strong knowledge of government and private insurance
  • CPT & ICD9 coding experience or certification
  • Experience with J codes
  • Available for 25% travel
  • Excellent communication skills (oral and written)
  • Able to work a rotational shift between the hours of 7:45am and 8:15pm – Mon to Fri
  • Bilingual English/Spanish preferred
16

Regional Reimbursement Specialist Resume Examples & Samples

  • Initiate and/or maintain ongoing communication with facilities to ensure timely, accurate receipt of patient insurance coverage information
  • Verify patient insurance with payors including eligibility and benefits related to outpatient surgery
  • Update Patient Registration and associated systems accurately and as required
  • Contact patient insurance carriers and obtain authorizations, referrals, and medication authorizations (pre-auths) for outpatient surgery services
  • Contact Primary Care Physicians to obtain referrals and pre-authorizations as needed
  • Enter referrals and authorizations into database
  • Enter PCP information into database
  • Partner with the teammates at the facilities (AC and AM) to resolve incomplete registrations
  • Serve as a backup if an Access Coordinator is out
  • Review registration denials to determine root cause
  • Determine Coordination of Benefits as required; maintain current patient account information at all times
  • Follow-up as necessary to ensure insurance changes are verified and line of coverage is reset
  • Complete all ancillary reports and assigned projects within established timeframes
  • Support Patient Account Specialists and other ROPS teammates as needed
  • Maintain confidentiality of all company and patient information in accordance with HIPAA regulations and DaVita policies
  • Minimum of three (3) years’ healthcare reimbursement experience preferred; experience with admissions, billing, and collections required
  • Demonstrated knowledge of insurance rules, regulations and Coordination of Benefits for federal, state, and/or managed care payors in multiple states required
17

Senior Reimbursement Specialist, Case Manager Resume Examples & Samples

  • 3 - 5 years in pharmacy, managed care, Medicaid and/or Medicare organizations, pharmaceutical and/or biotech manufacturer, medical office, or related similar field
  • Curiosity
  • Empathy
  • Swift Investigation
  • Effective Listening
  • Elaborate Thinking
  • Excellent Communication Skills (oral and written)
  • Use of / Access to Resources
  • Bi-lingual (English / Spanish – Native)
  • Ability to Present and Facilitate
18

Field Reimbursement Specialist Resume Examples & Samples

  • Provides customer and client specific reimbursement and access training and assistance to key client stakeholders. Address identified needs or gaps in product access knowledge, assists in overcoming access barriers. Conducts policy reviews and provides policy updates. Educates on claims management, billing and coding policy, and assists with prior authorizations and/or denials
  • Works cooperatively with client sales and market access teams to provide reimbursement and subject matter expertise on product and services. Provides timely responses to all inquiries; Provides subject matter expertise on all coverage issues. Demonstrates excellent market awareness; Assesses client levels of product outcomes and provides follow up to promote and maintain high level of customer satisfaction
  • Collaborates and coordinates with internal program team Provides guidance in and assists with the understanding of complex coverage challenges. Assists in the development of a coverage and access catalog for the local market
  • Collaborates and coordinates with manufacturer stakeholders Provides updates on coverage for local market stakeholders Collaborates and communicates on activities for awareness Attends relevant key strategic marketplace meetings and presentations
  • Bachelor’s degree required; Master’s degree preferred in relevant field
  • 8 - 12 years of experience; experience with a focus on patient access and reimbursement in Specialty/Pharma and/or Medical Device, or contract reimbursement services experience
  • Demonstrated proficiency with Microsoft Word, PowerPoint and Excel; current driver’s license and safe driving record; use of computer, mobile phone, printer and fax
  • Excellent verbal and written communication skills; presentation skills, Strong project management skills, Working knowledge of business financials, Negotiation and leadership skills are essential, Superior working knowledge of specialty product channels and a keen awareness of specialty product distribution, Results oriented; leverages effective influencing and relationship skills , Ability to build strong working relationships with colleagues and customers, Demonstrated ability to prioritize and manage work load independently; excellent time management, Solid leadership and ability to drive initiatives cross functionally; Ability and willingness to travel (extensively and on weekends at times) to meet goals, Excellent critical and analytical thinking capabilities, Driving focus on continuous improvement and innovation
19

Reimbursement Specialist Resume Examples & Samples

  • Collects and reviews all patient insurance benefit information, to the degree authorized by the SOP of the program
  • Provides assistance to physician office staff and patients to complete and submit all necessary insurance forms and program applications
  • Completes and submits all necessary insurance forms and electronic claims to process the claims in a timely manner as required by all third party payors. Researches and resolves any electronic claim denials
  • Researches and resolves any claim denials or underpayment of claims
  • Effectively utilizes various means for collections, including but not limited to phone, fax, mail, and online methods
  • Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly
  • Maintains frequent phone contact with provider representatives, third party customer service representatives, pharmacy staff, and case managers
  • Reports any reimbursement trends/delays to supervisor (e.g. billing denials, claim denials, pricing errors, payments, etc.)
  • Processes any necessary insurance/patient correspondence
  • Provides all necessary documentation required to expedite payments. This includes demographic, authorization/referrals, National Provider Identification (NPI) number, and referring physicians
  • Coordinates with inter-departmental associates to obtain appropriate medical records as they relate to the reimbursement process
  • Maintains confidentiality in regards to patient account status and the financial affairs of clinic/corporation
  • Communicates effectively to payors and/or claims clearinghouse to ensure accurate and timely electronically filed claims
  • Works on problems of moderate scope where analysis of data requires a review of a variety of factors. Exercises judgment within defined standard operating procedures to determine appropriate action
  • Typically receives little instruction on day-to-day work, general instructions on new assignments
  • Performs related duties as assigned
  • *Vietnamese speaking preferred***
  • Ability to communicate effectively both orally and in writing
  • Ability to build productive internal/external working relationships
  • Strong interpersonal skills
  • Strong negotiating skills
  • Strong mathematical skills
  • Strong organizational skills; attention to detail
  • General knowledge of accounting principles, pharmacy operations, and medical claims
  • General knowledge of HCPCS, CPT, ICD-9 and ICD-10 coding preferred
  • Global understanding of commercial and government payers preferred
  • Ability to proficiently use Microsoft Excel, Outlook and Word
  • Is developing professional expertise; applies company policies and procedures to resolve a variety of issues
20

Reimbursement Specialist Resume Examples & Samples

  • Bachelor's degree required along with relevant specific practice management experience preferred
  • Minimum two years' experience in public or private third party access arena or pharmaceutical industry in managed care, clinical support, or sales
  • Experience with allergy/respiratory products highly preferred
  • Establishing relationships within a practice by working closely with them to help remove access barriers to specialty products for their patients
  • Ability to operate as a "team player" in collaborating with multiple sales representatives, sales leadership, and internal colleagues to reach common goals
  • Knowledge of Centers of Medicare & Medicaid Services (CMS) policies and processes with expertise in Medicare Part D (Pharmacy Benefit design and coverage policy) a plus
  • Knowledge of Managed Care, Government, and Federal payer sectors, as well as Integrated Delivery Network/Integrated Health Systems a plus
  • Knowledge of access processes within the physician office
  • Ability to review clinical information in patient charts, understand and interpret payer policy to provide guidance to HCP offices on how they may proceed in filling out prior authorization/formulary exception/appeals documentation
  • General payer policy knowledge including managed care and Medicare/Medicaid
  • Foundational knowledge of benefit verifications and prior authorization requirements
  • Ability for up to 70% Travel
21

Reimbursement Specialist UBC Resume Examples & Samples

  • Provide day to day oversight and coordination
  • Act as single point of contact responsible
  • Recognize a product quality complaint and
  • BS degree or six years of relevant working experience
  • 0 - 2 years relevant experience in pharmacy
22

Cerner Reimbursement Specialist Resume Examples & Samples

  • Contact insurance carriers through website, email or telephone to resolve outstanding accounts
  • Analyze and resolve moderately complex insurance denials including coding review to prevent errors within appeals process
  • Appeal and/or resubmit unresolved invoices to insurance carriers
  • Research and respond to insurance correspondence
  • Update registration information, post denial codes and adjustments in practice management systems
  • Research and obtain required documents to resolve misdirected payment issues
  • Analyze weekly denial reports to spot trends; assess opportunities to improve internal workflows
  • Maintain internal logs (Excel format)
  • Assist in employee training and mentorship
  • Contact client for missing data elements or confirmation of information
  • Others may be assigned
  • High school diploma or equivalent
  • 2-4 years’ experience in healthcare collections and/or healthcare related field
  • Previous experience in Physician Office healthcare Collections preferred, willing to consider hospital collections exp
  • Previous experience with Cerner, IDX or Epic medical billing systems preferred
  • Knowledge of CPT, ICD-9 and HCPCS codes
  • Sharp intelligence of government payers and other commercial/managed care carrier rules and processes in a professional billing environment
  • Attention to detail with the ability to identify/resolve problems and document the outcome
  • Strong written and verbal communication skills
  • Excellent analytical and problem solving skills
  • Ability to multi-task and recognize trends to effectively work A/R
  • Solid skill with Microsoft Office applications: Word, Excel
  • Initiative to learn new tasks and the ability to apply acquired knowledge to future duties
  • Flexibility, adaptability and accountability are necessary for optimum client results
23

Field Reimbursement Specialist Resume Examples & Samples

  • Provides customer and client specific
  • Bachelor’s degree required; Master’s degree
  • Current, unrestricted driver’s license in
24

Field Reimbursement Specialist Resume Examples & Samples

  • Provides customer and client
  • 12 years of experience; experience with a focus on patient access and reimbursement
  • Current,
  • Demonstrated
25

Documentation & Reimbursement Specialist Resume Examples & Samples

  • Investigates, responds to and communicates information regarding complex coding, documentation, and/or compliance matters. Analyzes coding and/or documentation issues/questions from both a compliance and coding perspective. Performs research and provides recommendations for use of codes and/or documentation in a timely manner. Works closely with hospital administrators and faculty as appropriate, regarding complex coding/documentation issues
  • Develops educational materials, plans and conducts comprehensive coding and/or documentation training for a highly regulated healthcare process based on training needs of employees. Provides compliance/documentation educational sessions for physicians and other staff. Provides coding and/or documentation expertise for all compliance issues
  • Performs chart reviews for professional fees and/or outpatient and inpatient services billed through GECB and/or the hospital billing systems. Analyzes results and prepare formal reports with findings and recommendations. Facilitates and improves hospital staffs’ and/or physicians’ understanding of payor and regulatory requirements by providing feedback related to documentation information
  • Certification in any one of the following: RHIT, RHIA, CCS, CPC. Intermediate Comprehensive knowledge of ICD-10-CM, CPT and HCPCS coding. Intermediate Comprehensive and coding for professional services, utilizing ICD-10-CM, CPT and HCPCS
  • Clinical experience as a RN or LVN in a case management or case coordinator role with experience on patient status determinations, Internal and documentation
  • Clinical background as a RN or LVN with experience in medical auditing in an acute care setting
  • Clinical experience as a RN or LVN with expertise of case delivery documentation and related medical record documentation in an acute setting
26

Reimbursement Specialist Resume Examples & Samples

  • Contact insurance carriers through website, email or telephone to resolve outstanding accounts
  • Analyze and resolve moderately complex insurance denials including coding review to prevent errors within appeals process
  • Appeal and/or resubmit unresolved invoices to insurance carriers
  • Research and respond to insurance correspondence
  • Update registration information, post denial codes and adjustments in practice management systems
  • Research and obtain required documents to resolve misdirected payment issues
  • Analyze weekly denial reports to spot trends; assess opportunities to improve internal workflows
  • Maintain internal logs (Excel format)
  • Assist in employee training and mentorship
  • Contact client for missing data elements or confirmation of information
  • Others may be assigned
  • High school diploma or equivalent
  • 2-4 years’ experience in healthcare collections and/or healthcare related field
  • Previous experience in Physician Office healthcare Collections preferred, willing to consider hospital collections exp
  • Previous experience with IDX or Epic medical billing systems preferred
  • Knowledge of CPT, ICD-9 and HCPCS codes
  • Sharp intelligence of government payers and other commercial/managed care carrier rules and processes in a professional billing environment
  • Attention to detail with the ability to identify/resolve problems and document the outcome
  • Strong written and verbal communication skills
  • Excellent analytical and problem solving skills
  • Ability to multi-task and recognize trends to effectively work A/R
  • Solid skill with Microsoft Office applications: Word, Excel
  • Initiative to learn new tasks and the ability to apply acquired knowledge to future duties
  • Flexibility, adaptability and accountability are necessary for optimum client results
27

Reimbursement Specialist Resume Examples & Samples

  • Processes claims accurately and timely
  • Performs collection calls and is persistent with aging accounts
  • Notifies supervisor of problem accounts
  • Processes denials and secondaries promptly
  • Submits appropriate documentation for adjustments to supervisor
  • Acts as backup for intake coordinator when needed
  • Updates and maintains contract pricing
  • Assists month-end closing as scheduled to assure timeliness
  • Attends required in-services each year
  • Working knowledge of medical terminology
  • Knowledge of HCPCS coding
  • Knowledge of ICD 9 coding
  • Knowledge of electronic billing
  • Excellent calculation/math skills
  • Ability to understand insurance contracts for billing purposes
  • Ability to prioritize and handle multiple tasks and projects concurrently
  • Demonstrated knowledge and proficiency in the principles, procedures and best practices related to this position
  • Proficient level of software proficiency in using PC software to support activities, especially Microsoft Office
  • The ability to work with confidential material and maintain confidentiality is required along with sensitivity to employees and customers needs and data
  • Strong attention to detail
  • Proficient analytical skills
  • Proficient in MS Office
28

Senior Reimbursement Specialist Resume Examples & Samples

  • (Duties may include, but not limited to all or some of the following)
  • Conducts medical and pharmacy benefit insurance verifications and investigations for commercial and government payers
  • Builds relationships with patients, caregivers, HCSs, and Sales Team to collect / share information and coordinate participation in the program
  • Communicates with insurance companies, and third-party vendors to collect / share information and coordinate participation in the program
  • Researches available disease-specific information in the assigned region: events, activities, resources, support groups, etc
  • Handles complex calls in a call-center environment
  • Communicates with internal and external departments to facilitate coordination of information / resources
  • Reports Adverse Events (AE) and Product Quality Complaints (PQC), as required and as per policy
  • Strictly adheres to Standard Operating Procedures (SOPs)
  • Accurately interprets patient insurance, prescription and other health-related documentation, as needed
  • Validates and enters prescription orders, as appropriate
  • Completes casework in a timely manner with consistent follow-up as the accountable case manager
  • Maintains patient confidentiality
  • Advocates on behalf of the patient to problem-solve any issues or obtain necessary information
  • Understands prescription drug benefit management techniques including Formularies, Prior Authorizations, etc
  • Performs clerical and administrative functions such as mailing and faxing correspondence, data entry, scheduling, etc
  • Acquire/Exhibit/Maintain subject matter expertise in the area of the liver disease, including but not limited to the condition, treatment, community of patients and caregivers, activities and events offered throughout the country, etc., to ensure staff is providing the appropriate support / service(s)
  • Apply subject matter expertise to drive program offerings
  • Preferred experience
  • Social workers
  • Case workers / Case managers
  • Knowledge of US private and government payers
  • Working knowledge of Microsoft Office (Word, Excel, Outlook)
  • Curiosity
  • Empathy
  • Problem Solving
  • Swift Investigation
  • Analytics
  • Elaborate Thinking
  • Bi-lingual (English / Spanish – Native)
  • Able to work a rotational shift between the hours of 8am and 6pm– Mon to Fri
29

Field Reimbursement Specialist Resume Examples & Samples

  • Works cooperatively with client sales and market access teams to provide reimbursement and subject matter expertise on product and services. Provides timely responses to all inquiries; Provides subject matter expertise on all coverage issues
  • Demonstrates excellent market awareness; Assesses client levels of product outcomes and provides follow up to promote and maintain high level of customer satisfaction
  • Collaborates and coordinates with internal program team Provides guidance in and assists with the understanding of complex coverage challenges Assists in the development of a coverage and access catalog for the local market
  • Excellent verbal and written communication skills; presentation skills
  • Negotiation and leadership skills are essential
  • Leverages effective influencing and relationship skills
  • Ability to build strong working relationships with colleagues and customers
  • Demonstrated ability to prioritize and manage work load independently
  • Solid leadership and ability to drive initiatives cross functionally
  • Ability and willingness to travel (extensively and on weekends at times) to meet goals
  • Excellent critical and analytical thinking capabilities
  • Driving focus on continuous improvement and innovation
30

Reimbursement Specialist Resume Examples & Samples

  • Reviews and analyzes the reasons for variance using daily reports and tools. Variances include underpayments, overpayments and denials
  • Identifies variances that are due to inappropriate auto proration; reports to leadership for timely correction
  • Corrects manual or missing proration as per contract or explanation of benefits
  • Identifies inappropriate/denied payments based on Presence Health payor contracts
  • Initiates appeal letters or phone calls to all third party payors. Prioritizes appeal requests based on contractual appeal timeframes and Account Receivable dollars
31

Reimbursement Specialist Resume Examples & Samples

  • Performs error analysis for disputed/denied claims and provides recommendations for process improvements. Assists with third party audits when necessary
  • Investigates, evaluates, recommends and implements fee updates and new fees
  • Acts as a resource for information on public/private payer assistance and guidelines. Researches reimbursement issues as necessary
  • Trains and coaches staff regarding proper coding and reimbursement policies and procedures
  • Minimum five (5) years of experience directly applicable to the primary work required
32

Reimbursement Specialist Resume Examples & Samples

  • High school diploma or GED required
  • Bachelor’s Degree preferred
  • 1-3 years working in the Health Care environment required, preferably in an Infusion setting
  • Familiarity with generic billing formats: New 1500 and the UB04 billing forms
  • Ability to operate computer software, printers, photocopier, desktop calculator, fax machine, and other office-related equipment