Robert Half Finance & Accounting Billing Clerk in CEDAR KNOLLS, New Jersey
A company located near Hawthorne is looking for a Reimbursement Care Specialist to join their team. The Reimbursement Care Specialist works closely with Health Care Professionals, families, insurance companies, state reimbursement program administrators, our field sales organization and the Customer Service team to seek insurance coverage for the metabolic products. Key Responsibilities:
Understand the landscape of access to our Metabolic portfolio and where limitations exist, works through the process to overcome the challenge.
Expand coverage of our products in key geographies or with key authorities by: o Intervening, assisting, managing, and advocating for Metabolic patients coverage of our products with insurance companies and public service programs. o Navigating the payers system, then informing, counseling, and helping Metabolic patients and their families understand the results. o Communicating with insurance companies to verify policy information, obtain explanation of benefits, prior authorizations and find in-network providers. o Assisting medical professionals with health plan prior authorizations and pre-determinations to facilitate authorizations for our products. o Assisting our customers with coding and billing appeals and support, research and monitor insurance company policies (covered in bullet 1).
Review patient's Summary Plan Descriptions and insurance contracts to find any and all avenues of opportunities for coverage for our products.
If unable to find coverage with patient's existing insurance coverage, research for other avenues of coverage, for example, public service programs.
If unable to obtain coverage through insurance or public service programs, prepare patient case file, including liaising with the patient's dietitian, and propose patient for internal patient assistance program.
Execute and assist with the implementation of newly structured patient assistance program
Manage registration of all new Metabolic products with data banks.
Where possible obtain payer policies such as Medicare, health insurance companies, and coverage requirements by state. Maintain this information in a file on the shared drive.
Correspond quarterly with special program coordinators, i.e. state programs and develop relationships with the health care providers in the metabolic industry to promote NNA reimbursement care programs
Maintain a log of the status of all cases, update ACT database, and maintain patient records in accordance with all regulations (e.g., HIPPA).
Conduct outreach calls to targeted KOLs highly valued HCPs, offering coverage education and assistance, as needed.
Assist with the development adult coverage care program, to include outreach, directing patients to partnering clinics
Other duties as assigned. If interested in this position, please email resume to email@example.com or call Tom Breeman at 973-658-0035 for consideration.
Robert Half Finance & Accounting, the world's leader in specialized financial staffing, provides exciting full-time opportunities in the areas of accounting, bookkeeping, finance, audit, taxation and more. We pioneered the professional staffing industry, and we've been successfully matching professionals with employers since 1948. Our proven proprietary processes, along with our relationships in 325 locations worldwide, allow us to provide you unparalleled access to exciting career opportunities. But don't take our word for it. Our company once again was named first in our industry on Fortune® magazine's list of "World's Most Admired Companies" (March 1, 2017), and 9 out of 10 of our customers would recommend our service to a colleague.
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© 2017 Robert Half Finance & Accounting. An Equal Opportunity Employer M/F/Disability/Veterans
Req ID: 02750-0009321957
Functional Role: Billing Clerk
City: CEDAR KNOLLS
Postal Code: 07927
Compensation: $40,000.00 to $45,000.00 per year
Requirements: MS Excel