Reimbursement Specialist

Pittsburgh, PA - USA

Monthly Salary: Not Disclosed

Posted on: 22 hours ago

Vacancies: 1 Vacancy

Job Summary

At Johnson & Johnsonwe believe health is everything. Our strength in healthcare innovation empowers us to build aworld where complex diseases are prevented treated and curedwhere treatments are smarter and less invasive andsolutions are our expertise in Innovative Medicine and MedTech we are uniquely positioned to innovate across the full spectrum of healthcare solutions today to deliver the breakthroughs of tomorrow and profoundly impact health for more at

Job Function:

Customer Management

Job Sub Function:

Customer Service Operations

Job Category:

Business Enablement/Support

All Job Posting Locations:

Orlando Florida United States of America Phoenix Arizona United States Pittsburgh Pennsylvania United States of America Raleigh North Carolina United States

Job Description:

Ourexpertisein Innovative Medicine is informed and inspired by patients whose insights fuel our science-based advancements. Visionaries like you work on teams that save lives by developing the medicines of tomorrow.

Join us in developing treatments finding cures and pioneering the path from lab to life while championing patients every step of the way.

Learn more at are searching for the best talent for a Reimbursement Specialist to be in Pittsburgh PA Raleigh NC Phoenix AZ or Orlando FL.

Purpose:

TheReimbursementSpecialist (RS)is a professional role thathandles payer inquiries manages benefit investigations todeterminepatient eligibility and coverage and addresses coverage challenges. This role serves as the main contact for payers andcollaboratescross-functionally to support the patient service program.

Responsibilities:

Assess and analyzepatient benefits in coordination with internal program operations insurance providers and specialty pharmacy liaisons.

Work independently to complete assigned workin accordance withStandard Operating Procedures and defined service levels toreviewbenefitverification processresolve coverage challengesand answer inquiries.

Use high-level problem-solving skills to research cases and resolve independently using creativity innovationand professional judgement to make sound decisions.

Maintain frequent phone contact with payers to gather all necessary information related to case/patient information insurance coverageprior authorization (PA)andappeals processing.

Efficiently processpatient and prescriber requeststoaccelerateaccess to therapy.

Serve as expert on payer trends product access and reporting reimbursementinsightsand/or delaysi.e.denialsordelays.

Frequentlycommunicatewith program managementonnew insurancerequirements and trends.

Collaborate with internal& externalstakeholdersbyprovidingreimbursement informationas needed

Maintainaccurate compliant documentation and communication to support program goals.

Uphold patient privacy laws and foster collaborative team relationships.

Other duties as assigned.

Required Qualifications:

High school diplomaor equivalent.

Minimum of 2years of experience incasemanagement or insurancerolespreferably within apharmacyHUBorhealthcare setting.

Experience using an outbound calling platform to make external calls

Ability to independently manage case load prioritize work and usetime management skills to meetservice level agreements

Ability to efficiently navigate multiple screens and systems to perform work.

Ability to work assigned 8hrshift between program operating hours of 8am-8pm EST.

Proven ability to manage a case load prioritize tasks and build relationships.

Apply company policies and procedures to resolve challenges

Ability to proficiently use Microsoft programs.

Ability to thrive in a regulated remote high-volume environment

Preferred Qualifications:

UndergraduateDegree

Understanding of plan types Government Commercial Medicaid VA Fed

Knowledge of insurance structure (ex PBMs major medical plans co-pay assistance /cards)

Working Knowledge of Third-Party and other Foundation programs

Basic understanding of Co-Pay Assistance

Understanding ofHUB patientjourneyworkflow andtriageis a plus.

Possess a strong understanding of biologic/specialty pharma market and patient access challenges

#Li-Remote

Johnson & Johnsonisan Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race color religion sex sexual orientation gender identity age national origin disability protected veteran status or other characteristics protected by federalstateor local law. We actively seek qualified candidates who areprotectedveterans and individuals with disabilities as defined under VEVRAA and Section 503 of the Rehabilitation Act.

Johnson & Johnsoniscommitted to providing an interview process that isinclusive ofour applicants needs. If you are an individual with a disability and would like to requestan accommodation external applicants please contact us via internal employees contactAskGSto be directed to your accommodation resource.

Required Skills:

Preferred Skills:

Accountability Communication Customer Analytics Customer Centricity Customer Service Philosophy Customer Support Operations Customer Support Platforms Customer Support Policies and Procedures Customer Support Trends Detail-Oriented Inquiry Handling Issue Escalation Order Processing Process Oriented Service Excellence Service Request Management

Required Experience: