Reimbursement Specialist

Job Summary:

The HUB Services Reimbursement Specialist is responsible for gathering, applying, coordinating, and communicating financial, assistance program, and insurance information to determine drug coverage availability, issues, and options. The below is intended to describe the general content of and requirements for the performance of this job and is not to be construed as an exhaustive statement of essential functions, responsibilities, or requirements.

Primary Duties and Responsibilities

1.Communicate and interact with government and commercial payers to identify (i) availability of drug coverage; (ii) patient eligibility for coverage; (iii) prior authorization requirements; (iv) coordination of benefits and primary and secondary coverages; and (v) plan limitations (i.e., maximum quantity per order, refill too-soon, timely filing), and accurately communicate the same to patients and healthcare providers.

2.Provide information on coverage and reimbursement issues to patients and healthcare providers, and work on patient’s behalf to identify and assess reimbursement coverage options.

3.Address claim rejections/denials, identifying reasons for rejections.

4.Identify and communicate financial options for those with financial need.

5.Coordinate with stakeholders (including payers, assistance programs) to facilitate reimbursement process.

6.Establish relationships, develop trust, and maintain rapport with patients and healthcare providers.

7.Follow program guidelines and assist management.

8.Ensure confidentiality of all patient accounts by following Anovo HIPAA policies and procedures and properly reporting any suspected or known incidents.

9.Complete all required training in a timely manner and score a passing score on any training that requires a test score.

10.Conduct timely calls with patients and payers as necessary, and appropriately and professionally manage such calls.

13.Adhere to Anovo Code of Conduct and all applicable Anovo policies and procedures, including without limitation, attendance, being on-time, and not working overtime without permission.

14.Effectively and timely completes reports and special projects as requested by HUB services management and/or by client.

15.Regular and reliable attendance expected.

16.Other work-related duties as assigned by supervisor/manager.

Minimum Knowledge, Abilities, and Skills Required

1.Minimum High School Diploma.

2.Must have at least one year of reimbursement, healthcare billing or HUB experience.

3.Must have excellent computer and typing skills; Proficient in Microsoft Office Suite, primarily Word, PowerPoint and Excel.

4.Must be initiative-taking, people friendly, organized, and meticulous.

5.Willing to work the assigned shift to cover the hours of operation of the HUB Program. Anovo's operating hours are Monday-Friday, 7am-7pm. Must be willing and able to work the assigned shift in-office, and/or on an at home rotation.

6.Diligence and commitment follow through in communication with patients and providers.

7.Empathic listening skills to interact effectively with patients and providers.

8.Ability to communicate effectively orally and in writing.

9.Willingness to work in fast paced environment and can multi-task.

10.Strong customer service experience and skills.

This description is intended to be only a general outline of major activities. It is expected that the employee performs these and any other activities which may be assigned, or which may occur in the normal course of work. This description is not a contract or guarantee of employment. AnovoRx is an Equal Opportunity Employer.