Reimbursement Specialist - Healthcare determines the extent to which patients' insurance covers their treatments. Reviews appropriateness of CPT-4/ICD-10 coding and determines if care provided corresponds to the charges submitted. Being a Reimbursement Specialist - Healthcare ensures compliance with Federal and State regulations and company policies that govern Medicare and state payment systems. May assist in identifying fraudulent non-plan billing practices and assists the legal department with litigation preparation. Additionally, Reimbursement Specialist - Healthcare may require a bachelor's degree. Typically reports to a supervisor or manager. Typically requires Certified Professional Coder (CPC) from AAPC or AHIMA. The Reimbursement Specialist - Healthcare gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Reimbursement Specialist - Healthcare typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)
Job Description
Provides mission critical support to Novartis brands by helping patients regarding prescribed products with assistance to address any access challenges and get on medications needed to improve their health.
• If you are customer-obsessed.
• If you are energized by leading people through change.
• If you are motivated by measured outcomes.
You should consider joining the Reimbursement Specialist Team.
Overview:
The Reimbursement Specialist will be responsible for providing support and information about the insurance coverage of their prescribed Novartis medicines. They will accurately and efficiently find the patient’s insurance coverage, and any other requirements by leveraging reimbursement tools and collaborating with payers and providers.
The Reimbursement Specialist may also share appropriate information with Patient Specialty Services field teams. This information may cover coverage-related queries from customers, provide pre-authorizations for medical treatment, and outline information regarding co-payments.
The Reimbursement Specialist must have strong communication skills to converse with payors and providers about benefits coverage and be able to offer solutions in accordance with approved procedures.
A Reimbursement Specialist will possess an aptitude for learning and continual development.
• Develop and maintain knowledge of programs and payer coverage; broaden program knowledge over time.
• Learn and utilize protocols, information and technology to gather patient coverage information. Some of this will be completed via phone calls to payers in a prompt and courteous manner.
• Prepare proper documentation and notifications; perform proper escalation, tracking, and follow-up
• Evolve skills to navigate the payer landscape regarding company programs over time
• As applicable, raise innovative ideas which will drive improved efficiency and effectiveness of customer service to Team Leads.
What you’ll bring to the role:
Education:
Requirements:
Experience:
Required Experience:
Preferred Experience: