- Reimbursement Case Manager will serve as an expert on reimbursement issues and be responsible for handling the day-to-day activities within reimbursement services (benefits investigation, prior authorizations and appeals support)
- Complete medical and/or pharmacy benefit investigations, identify and facilitate submission of required documentation for payer/plan review for prior authorization, step edit identification and appeals according to program standard operating procedures.
- Knowledge and understanding of the different types of major payers including private/commercial and government (Medicare, Medicaid, VA, DoD)
- Maintains records in accordance with applicable standards and regulations to the programs/promotions
- Responsible to determine coverage availability and coordinate the financial aspects of healthcare services to ensure patients have access to prescribed therapy
- Follow program guidelines and escalate complex cases according to program policy and procedures
- As a program's "eyes and ears", works with the Franchise Program Manager, and Client on a day-to-day basis to maintain open lines of communication and share awareness regarding therapy access restrictions, policy changes and other changes in the reimbursement landscape
- Understand health and disease states of patients of the programs/promotions
- Maintains a high level of ethical conduct regarding confidentiality and privacy
- Incumbent may be asked to perform related job duties that are not specifically set-forth in this job description.
- Medical Reimbursement
- Insurance Verification
- Medical Terminology
- Pharmacy Benefits
- Benefit Investigation
- Prior Authorization
- Appeals
- Insurance Payer Experience/Call Center
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Pharmacy Benefit Specialist - Morrisville, United States - TEKsystems
Description
Job Description
Job DescriptionAs the Pharmacy Benefits Specialist
If you're ready to explore the next step in your career:
You'll enjoy...
Career Opportunities – Tons of growth opportunities for your career
Standard Hours – 100% Onsite. Monday-Friday (8:00am - 5:00pm)
Competitive Pay - $ /hr (depending on years of experience)
Expedited Interviews – Access to additional Resume support and pre-interview questions
A day in the role...
Experience:
We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.
The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
