Reimbursement Analyst

🕒 May 5

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Gifthealth

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2020

☁️ SaaS

💊 Pharmaceuticals

🤝 B2B

💰 $40M Private Equity Round - GiftHealth on 2023-04

SaaS • Pharmaceuticals • B2B

Gifthealth is a technology-enabled patient access and prescription fulfillment company that connects patients, prescribers, pharmacies, and pharmaceutical manufacturers through a unified digital platform. It streamlines enrollment, electronic benefits verification, e-prior authorization, and payment/affordability support while managing pharmacy fulfillment and patient support services. The platform also provides manufacturers with actionable data and insights on patient journeys and brand performance, driving faster, more reliable medication access.

📋 Description

• Assist patients and healthcare providers with moderate to complex billing and coding, insurance benefit investigations, prior authorization, appeals and patient assistance support programs inquiries. • Manage patient cases and interact with external contacts like payers and other stakeholders. • Assist with coordination of relevant tasks/activities between Gifthealth and the client. • Review and resolve denied or underpaid insurance claims. • Identify and assess patient specific insurance coverage options for client specific products. • Reverify patient benefits at predetermined time frames. • Document all activities in program database within required timelines. • Research payer medical policy. • Monitor and update payer prior authorization requirements and coverage policies for specified client program. • Prepare and/or assist with preparation of reports as requested, including adverse event and product complaint reports. • Review and process documentation to determine patient specific eligibility for client patient support program(s), as appropriate. • Complete quality monitoring and quality assurance activities, as assigned. • Travel to and attend client meetings, off-site training, and/or conferences. Travel time estimate: 5%.

🎯 Requirements

• Minimum four years recent healthcare experience (2 years’ direct industry preferred). • Exhibit proficiency in Microsoft Office products • Excellent customer service skills (call center experience preferred). • Advanced problem solving, research and analytical skills. • Advanced communication skills, both written and verbal. • Attention to detail, data entry accuracy required. • Ability to multi-task and manage time independently. • Client interaction experience preferred. • Advanced knowledge of medical insurance (public and commercial), billing and coding and associated terminology.

🏖️ Benefits

• Equal Employment Opportunity (EEO) Statement