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Job details
 
Job Title: Insurance Reimbursement Specialist-4
Job Category: Insurance
Job description:  
POSITION SUMMARYThe Insurance Reimbursement Specialist is primarily responsible for verifying insurance benefits, obtaining prior authorizations and reauthorizations and validating accurate billing information to ensure claims are paid for drug shipment. Accurate documentation of payer information and patient status. Daily communication with patients, payers and physician offices regarding program status and financial responsibility. Assessment for ancillary program (Voucher, Coupon, PAP) eligibility with available. Understanding of the Risk Evaluation and Mitigation Strategies (REMS) program and report per product specific requirements. Identify potential adverse events and transfer to a clinical program member.ESSENTIAL FUNCTIONSDetermine program eligibility. Verify patient benefits for all assigned patients within program required timeframes. Facilitate prior authorization process within the required timeframes. Communicate patient responsibility timely and accurately. Asses and refer appropriately for special programs when available.Act as single point of contact for an assigned group of prescribers. Effective and timely communication with prior authorization and/or patient enrollment status.Complete accurate entry of billing information to ensure timely payment and avoid delay in patient therapy. Communicate with payers for claim rejection resolution.Identify and report events as required based on the REMS requirements for specified medication. Recognize potential adverse event and forward caller/written information to a clinical team member for reporting to the manufacturer. Recognize a product quality complaint and forward caller/written information to a pharmacist for reporting to the manufacturer. Recognize potential risk events and forward the caller/written information to a pharmacist for assessment and reporting to the manufacturer.Accurate and timely documentation of payer, billing information and patient status within the operations systems.QUALIFICATIONSHS degree or equivalent; Minimum of 2 years secondary education preferred.4-6 years relevant experience in pharmacy benefit management; Previous insurance experience preferredPharmacy Technician - Licensures/Certifications.Basic computer knowledge - Microsoft Word and Excel; AS400 a plus.Knowledge of medical terminology and claims processing jargon. Excellent written/verbal communication to include providing clear instructions.Ability to multitask.ABOUT THE DEPARTMENTUBCUnited BioSource Corporation (UBC), a subsidiary of Express Scripts, is a leading provider of pharmaceutical support services, partnering with life science companies to make medicine and medical products safer and more accessible. Our services support the full lifecycle of medicine and medical products, including development, commercialization, and long-term value and safety.

While UBC offers employment within Patient Support, Nursing, Pharmacy and Corporate, two main focus areas for the company are Clinical Development & Research and Safety & Risk Management. Members of the Clinical Development and Research teams help evaluate study protocol, target study population, recruit physicians and patients, and collect, clean, validate and report data. As a result, sponsors are able to submit findings to regulatory authorities or make a no-go decision in a timely and clear-cut manner. Additionally, our Safety and Risk Management teams develop, deliver, and report evidence to reinforce safe and appropriate product use. Through our Patient Access services, we help patients begin therapy quickly and remain on therapy, building strong relationships with patients to ensure optimal care.

UBC aligns with Accredo and CuraScript SD, also part of the Express Scripts family, to provide best-in-class, integrated services.ABOUT EXPRESS SCRIPTS Advance your career with the company that makes it easier for people to choose better health.Express Scripts is a leading healthcare company serving tens of millions of consumers. We are looking for individuals who are passionate, creative and committed to creating systems and service solutions that promote better health outcomes. Join the company that Fortune magazine ranked as one of the "Most Admired Companies" in the pharmacy category. Then, use your intelligence, creativity, integrity and hard work to help us enhance our products and services. We offer a highly competitive base salary and a comprehensive benefits program, including medical, prescription drug, dental, vision, 401(k) with company match, life insurance, paid time off, tuition assistance and an employee stock purchase plan.Express Scripts is committed to hiring and retaining a diverse workforce. We are an Equal Opportunity Employer, making decisions without regard to race, color, religion, sex, national origin, age, veteran status, disability, or any other protected class. Applicants must be able to pass a drug test and background investigation. Express Scripts is a VEVRAA Federal Contractor.
Skills:  
Employment type:
  • Full Time
Salary Range: Unspecified
Job Link: You must first register to view this information.
 
Other Information
 
Degree:
Experience (year): 0
Job Location: Saint Louis - Missouri - USA
Zipcode: 63121
 
Post Date: 09/19/2017
 
Contact Information
 
Contact Name: Express Scripts
 


 
    

 
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