Reimbursement Specialist

🔥 0 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

👻 Ghost score 10%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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CareMetx, LLC

WebsiteLinkedInAll Job Openings

501 - 1000 employees

💼 Consulting

🏥 Healthcare

⚕️ Healthcare Insurance

Consulting • Healthcare • Healthcare Insurance

CareMetx, LLC is a company that specializes in transforming patient access to specialty therapeutics by reducing the time to therapy. They offer a digital Hub service that addresses emotional, financial, and clinical barriers for patients, aiming to improve treatment timelines and ongoing therapy use. CareMetx provides high-touch support and utilizes advanced technology to offer solutions for access, affordability, and adherence, benefiting both patients and healthcare providers. They partner with specialty pharmaceutical brands, healthcare providers, and hospital systems to enhance patient outcomes.

📋 Description

• Perform reimbursement functions including benefit investigations, prior authorization support, and call triage • Respond to provider account inquiries • Document provider, payer, and client interactions in the CareMetx Connect system • Obtain necessary data for prior authorization requests • Collect and review patient insurance benefit information • Assist physician office staff and patients with insurance forms and program applications • Complete and submit insurance forms required by third-party payors for prior authorizations • Track and follow up on prior authorization requests • Provide customer service and resolve or escalate customer requests and complaints • Maintain phone contact with provider representatives, third-party customer service representatives, and pharmacy staff • Report reimbursement trends and delays to the supervisor • Process insurance and patient correspondence • Provide documentation to expedite prior authorization requests, including demographics, authorizations/referrals, NPI numbers, and referring physicians • Coordinate with inter-departmental associates • Communicate with payors to ensure accurate and timely benefit investigations • Analyze moderately scoped problems and determine appropriate action within standard operating procedures • Report adverse events according to training and standard operating procedures • Maintain regular and reliable attendance • Perform other related duties as assigned

🎯 Requirements

• High School Diploma or GED required • 1+ years of experience in a specialty pharmacy, medical insurance, physician’s office, healthcare setting, and/or related experience • Ability to communicate effectively both orally and in writing • Ability to build productive internal/external working relationships • Strong interpersonal skills • Strong negotiating skills • Strong organizational skills and attention to detail • General knowledge of pharmacy benefits and medical benefits • Global understanding of commercial and government payers preferred • Proficiency in Microsoft Excel, Outlook, and Word • Ability and initiative to work independently or as a team member • Problem-solving ability • Strong time management skills • Customer satisfaction focus • Must be flexible on schedule and hours • Overtime may be required from time to time • Must be willing to work weekends if required to meet company demands • Equivalent combinations of experience and education are accepted

🏖️ Benefits

• Flexible schedule and hours • Overtime opportunities as required • Equal employment opportunity protections • Reasonable accommodations for individuals with disabilities

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