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Job Title: Drug Reimbursement Specialist

Must reside in the following states: AL, AZ, FL, GA, IL, IN, KS, KY, MI, MN, MO, NC, NJ, OH, OK, PA, TX, VA

JOB SUMMARY

Drug Reimbursement Specialists are responsible for communicating and working with patients to identify methods of payments. Works directly with insurance companies, drug assistance programs, and medical billing staff to manage billing and reimbursements for injectable medications. 

ESSENTIAL DUTIES AND RESPONSIBILITIES

Be proactive in running appointment reports to determine which patients will need a new prior authorization one to two weeks in advance

Keep authorization alerts in both EPM and EHR up to date

Be knowledgeable of all insurance plans, benefits, and coverage

Be available in the clinic during injections to assist in any insurance changes, billing questions or new patients requiring new assistance programs or authorizations.

Be available for patients to contact for assistance fund billing questions, assistance program information, enrollment, and re-enrollment

Have the knowledge to obtain and provide a benefit investigation to the requesting physician Have the customer service skills to communicate with the patient in a way that the elderly patient can understand

Have the knowledge of insurance plans and which plans require step therapy-step edits

Keep communication with drug representatives regarding insurance changes and authorization requirements

Keep up to date on which doses of medication can be used with which diagnosis

Be able to fill out prescription information on all authorization forms and understand which chart notes are sufficient for authorization requests

Task Dr's and scribes to make corrections to chart notes that are not sufficient for authorization request

Keep up to date on prescriptions with the specialty pharmacy for free medications

Knowledge of which insurance plans require their patients medication to be shipped from the preferred specialty pharmacy instead of buy and bill medications

Coordinate shipments every month for free drug patients Document when shipments will be delivered and make sure they are put into refrigeration in a timely manner.

Adheres to all safety policies and procedures in performing job duties and responsibilities while supporting a culture of high quality and great customer service.

Performs other duties that may be necessary or in the best interest of the organization

EDUCATION & CERTIFICATION REQUIREMENTS

• High school diploma or equivalent required

EXPERIENCE REQUIREMENTS

Previous medical office experience preferred; previous ophthalmic experience strongly preferred.

Knowledge, Skills and Abilities Requirements

Professional in appearance and actions Logical and Critical thinking skills

Customer-focused with excellent written, listening and verbal communication skills

Enjoys learning new technologies and systems

Detail oriented, professional attitude, reliable 

Exhibits a positive attitude and is flexible in accepting work assignments and priorities

Meets attendance and tardiness expectations

Management and organizational skills to support the leadership of this function 

Ability to follow or provide verbal & written instructions with sufficient grammar and spelling skills to avoid mistakes or misinterpretations

Interpersonal skills to support customer service, functional, and team mate support need

                   o Able to communicate effectively in English, both verbally and in writing 

Ability for basic to intermediate problem solving, including mathematics

Basic to intermediate computer operation o Proficiency with Microsoft Excel, Word, and Outlook

Specialty knowledge of systems relating to job function

Knowledge of state and federal regulations for this position; general understanding of HIPAA guidelines

Location/Work Environment:

For remote team members, HIPAA compliant home office environment. Ability to work in a remote environment while performing required duties and remaining patient focused. Able to work varying shifts including early mornings/evenings to attend meetings and cross training or support other initiatives.

EyeCare Partners is an equal opportunity/affirmative action employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.   Please do not contact the office directly - only resumes submitted through this website will be considered

NOTE:  Job descriptions are intended to be accurate reflections of those principal job elements essential for making fair pay decisions about jobs. Nothing in this job description restricts management right to assign or reassign duties and responsibilities to this job at any time.