Intake/Reimbursement Specialist

As a member of the pharmacy team, the Reimbursement Specialist uses strong customer service skills and knowledge of authorization and reimbursement practices to ensure patients fast, easy and appropriate access to pharmacy services. The Reimbursement Specialist accepts and processes referrals, identifies payer sources, verifies benefit information and acquires initial authorization as needed to begin patient service or to determine denial of patient service. This position also follows up on pending unresolved coverage issues and claim denials and documents and communicates to appropriate providers and internal department's accurate authorization information on current or potential patients. This position may also complete the patient intake process, schedule patient appointments and partner with care team and external resources to ensure efficient patient flow as assigned

Responsibilities

• Using strong knowledge of insurance, pharmacy practice, revenue cycle and in accordance with department Standard Operating Procedures (SOPs) and any regulatory or compliance requirements:
• Perform verification of insurance benefits, analysis and identify any potential coverage issues
• Assure fast, easy access to pharmacy services while documenting accurate referral and reimbursement (payer) information, coordinating the intake and benefit authorization process
• Assist in resolving problems with payers and provide information and expertise to other departments.
• Partner with potential international and self-pay patients on any financial or service needs related to their care as assigned.

Required Qualifications

• 2 years experience in a pharmacy setting or with revenue cycle, health insurance or benefit experience using an enterprise software system in healthcare or insurance organization

Preferred Qualifications

• Bachelor of Science in business, communications, health care or related field.
• 2 years revenue cycle, health insurance or benefits experience using an enterprise software system in the assigned clinical area or service line of a complex healthcare organization.
• Knowledge of ICD9 and ICD10 coding.

Fairview offers a generous benefit package including but not limited to medical, dental, vision plans, life insurance, short-term and long-term disability insurance, PTO and Sick and Safe Time, tuition reimbursement, retirement, early access to earned wages, and more! Please follow this link foradditional information: https://www.fairview.org/careers/benefits/noncontract

An individual's pay rate within the posted range may be determined by various factors, including skills, knowledge, relevant education, experience, and market conditions. Additionally, our organization prioritizes pay equity and considers internal team equity when making any offer. Hiring at the maximum of the range is not typical. If your role is eligible for a sign-on bonus, the bonus program that is approved and in place at the time of offer, is what will be honored.