We at MHealth Fairview are looking for you to join our amazing team! This benefits eligible position is a 1.0FTE(80 hours/2 weeks) on the day shift!

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

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.

Serve as a resource to the affiliations, staff and physicians regarding Fairview’s pharmacy services in assigned area. Assist with the coordination of services by communicating effectively and in a timely manner with others.

Maintain current knowledge of payer requirements and general admitting practices including use of on-line verification applications and initial and ongoing training.

Other administrative responsibilities as assigned.

Required

Education

• Experience
  • 2 years of 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

• Education
  • Bachelors’ degree in business, communications, health care or related field.

• Experience
  • 2 years 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 ICD10 coding. Knowledge of medical benefit investigation and securing or prior authorization securing for medical benefit.
• License/Certification/Registration
  • Pharmacy certification with the Pharmacy Technician Certification Board. If Minnesota Board of Pharmacy registration on or after 1/1/2013, must have a certificate of completion from a MNBOP approved employer based or vocational/technical training program
  • Nationally certified. Certifying exams must have National Commission for Certifying Agencies (NCCA) accreditation, with examples including, Pharmacy Technician Certification Board (PTCB) exam and The Exam for Certification of Pharmacy Technicians (ExCPT).