Reimbursement Specialist - CornerStone Staffing

CornerStone Staffing is hiring for6Patient Access/Reimbursement Specialistsreps in Cary, North Carolina

Ideal candidate has familiarity with benefits investigation, claims, copay assistance knowledge

Work for one of the largest independent specialty pharmacies that specializes in rare diseases and cancer medications.

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Location:Cary, North Carolina (Hybrid)

Pay:$19.50/hr

Schedule:Monday Friday *available for shift between 8am - 8pm EST | flexible for OT & Weekends

Training: 100% onsite

Essential Duties and Responsibilities:

• Works in a fast paced, high-volume contact center environment with a variety of product support programs managing complex reimbursement issues.

• Works closely with healthcare providers and patients to assist with appeal management for claim denials.

• Works with physicians and payers to advocate for product specific coverage per payer specific P&T Committee protocol therefore, must possess the ability to communicate product benefits and efficacy and positively influence payer policy.

• Must have an in-depth understanding of insurance plans and benefit structures in order to obtain detailed benefit information and maximize plan benefits.

• Obtains payer specific prior authorization procedures and documentation requirements if applicable and facilitate the prior authorization process for patients and healthcare providers.

• Needs to have an in-depth understanding of Medicare and Medicaid programs in order to effectively utilize internal resources and to conduct external research to identify alternate funding sources as appropriate.

• Position may require sales, project management and/or account coordination skills depending on the specific program.

Minimum Requirements

• 2+ years customer service experience

• 2+ years medical or insurance industry experience

Critical Skills

• 5 years experience in the healthcare industry including, but not limited to, Medicare and/or Medicaid program administration, insurance verification and/or claim adjudication, physician s office or outpatient billing, pharmacy and/or pharmaceutical manufacturers

• Must be able to analyze reimbursement specific data and prepare written reports for management and client communications.

Additional Knowledge & Skills

• Excellent communication and organizational skills

• Strong problem solving and decision making skills

• Ability to effectively handle multiple priorities within a changing environment

• Strong Interpersonal skills

• Strong oral and written communication skills

• Computer literacy

• ICD-9, HCPCS, CPT experience

Education

• HS Diploma or Equivalent

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