Job Summary
The role supports the Patient & Revenue Retention Manager in the financial review process, ensuring cost-effectiveness by analyzing new referrals, existing patients’ health plan fee schedules, and other reimbursement databases. Key responsibilities include evaluating payer reimbursement methodologies, reviewing patient insurance benefits, and educating patients about available drug brands and copayment assistance programs. This position is designed to enhance patient onboarding and ongoing care by ensuring new and existing patients are informed of all available healthcare benefit options.
Schedule Details
Location:
On-Site (Laguna Hills, CA.)
Hours:
Monday-Friday 8:30 AM – 5:00 PM
Duties and Responsibilities
- Assist with the reimbursement review and determination process within specialty operations.
- Review new referrals to ensure cost-effectiveness based on payer fee schedules and/or contracted rates, utilizing both In/Out-of-Network benefits from the patient’s health plan.
- Generate ad-hoc reports on profitability, cancellations, and other relevant categories.
- Educate and guide patients on AmeriPharma’s products and services, including financial assistance options when applicable.
- Provide clear explanations of healthcare insurance benefits, including coverage details, copayments, deductibles, and network restrictions.
- Accurately document patient interactions, insurance details, and other relevant information in the electronic health record (EHR) system.
Required Qualifications
- Strong patient care and customer service skills.
- Strong business acumen, problem-solving, and analytical skills.
- Knowledge of medical and pharmacy reimbursement methodologies.
- Familiarity with various types of health insurance benefits and patient access/copayment assistance programs in the marketplace.
Education and Experience Requirements
- Associate’s degree.
- Minimum of 2 years of experience in specialty pharmacy setting
- Minimum of 2 years of experience with payer reimbursement methodologies within the healthcare revenue specialty reimbursement industry; experience with Medicare Part B & D is preferred.
