Reimbursement Specialist Resume Samples

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R Thiel

Reilly

Thiel

70335 Deckow Mountains

Houston

+1 (555) 673 6731

70335 Deckow Mountains

Houston

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

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

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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

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

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

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

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

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

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

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)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Field Reimbursement Specialist Resume Examples & Samples

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

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

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

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

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

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

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

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

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

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

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