Job Summary:
The Reimbursement Account Liaison is responsible for managing the financial activities of patient payers, from the time products or services are dispensed until the payment cycle ends. Acting as a liaison between manufacturer accounts sales, billing departments and health clinicians, reimbursement accounts liaisons manage all functions regarding claims processing, such as overseeing disputed, delayed, or rejected claims. In addition to being communicative, they need to be independent, decisive, and interpersonal as they interact with patients; state, federal and private representatives, fiscal intermediaries; manufacturer and pharmacy partners and managed care case managers. 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
Reporting reimbursement trends and issues to managed care organizations and departments, as well as informing business services divisions of implementations on renewals or new contracts. Maintain working relationships with payer parties, such as insurance companies and government agencies, to fix slow payment issues or reimbursement problems. They keep up on outstanding claims until the final payment is made. Communicate with patients, families, doctors, manufacturer account sales and office personnel to answer medical billing inquiries or questions about coverage on certain procedures. Track denials within the database to monitor underpayment occurrences. Regularly report to management regarding any payer policies, rates, procedures, or changes that will affect their company. Active in meetings, where they update staff on progress or problems and consider coworkers’ suggestions for improving service quality or processes. Identify professional and productive relationships with potential customers. Coordinate with account teams to ensure business success. Provide excellent customer service to ensure customer satisfaction. Manage all front-end paperwork for customer accounts. Coordinate and manage customer account documentation. Document, track, and resolve all plan providers’ billing and payment issues. Research verbal and written providers’ claims inquiries. Collaborate with various business units to resolve claims issues and provide instruction to providers’ billing staff and services regarding claims submission policies and procedures to ensure prompt and accurate claims adjudication. Identify authorization issues and trends. Direct and educate Provider Services and Relations with the claims reprocessing notification, utilizing knowledge of provider billing and claims processing. Analyze trends in claims processing issues and assist in identifying and quantifying issues and reviewing work processes. Identify providers experiencing claims issues, or those that have the potential to develop claims issues, and proactively work to eliminate barriers for accurate and timely claims processing. Identify potential and documented eligibility issues and notify applicable departments to resolve them. Meet with providers to discuss claims payment policies and procedures and resolve claims issues. Handle provider additions, changes and terminations as identified. Run claims reports regularly through provider information systems. Assist the supervisor with compiling and preparing data for the Daily Dedicated Dashboard reporting. Report on the current patient statuses in the Dedicated Pharmacy Dashboard meetings. Regular and reliable attendance expected. Other work-related duties as assigned by supervisor/manager.
Minimum Knowledge, Abilities, and Skills Required
Bachelor’s degree or related experience required. At least 4 years of relevant experience and strong knowledge base in healthcare policy and reimbursement for all payer types including Commercial, Medicaid and Medicare. Experience with relationship-building with customers. Relevant work experience to give presentations audio conferences and face-to-face visits. Strong organizational skills. Extremely detail-oriented. High level of professionalism. Strong customer service skills. Excellent written and verbal communication skills. Excellent computer skills - MAC or PC. Strong spreadsheet and database management.
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.
