Intake Reimbursement Specialist

Job Overview

Our Fairview Pharmacy Solutions team is growing and we are seeking the perfect team members to join us in making an impact in the Pharmacy world. 

 

Job Info: Fully Remote, 1.0 FTE (80 hrs/2 weeks) Monday-Friday; mostly day shift but must have flexibility to help clients across different timezones. 

 

The Intake 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. This role will provide services for management of Fairview Homes Infusion as well as external customers.  This includes consulting and training services for external consulting engagements.    

 

This role 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 role will provide services for management of Fairview Homes Infusion as well as external customers.  This includes consulting and training services for external consulting engagements.

  

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.

 

Minimum Qualifications to Fulfill Job Responsibilities:

Required

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

 

License/Certification/Registration

Revenue Cycle Certification (HFMA – CRCR); ( and/ or 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.

If certification requirements are not met – 3 additional years of experience would be equivalent.

 

Preferred

Education

Bachelor’s degree in business, communications, health care or related field.

 

Experience

2 years of revenue cycle, 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 ICD9 and ICD10 coding.

 

License/Certification/Registration

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). 

Benefit Overview

Fairview offers a generous benefit package including but not limited to medical, dental, vision plans, life insurance, short-term and long-term disability insurance, PTO and Sick and Safe Time, tuition reimbursement, retirement, early access to earned wages, and more! Please follow this link for additional information: https://www.fairview.org/careers/benefits/noncontract

Compensation Disclaimer

An individual's pay rate within the posted range may be determined by various factors, including skills, knowledge, relevant education, experience, and market conditions. Additionally, our organization prioritizes pay equity and considers internal team equity when making any offer. Hiring at the maximum of the range is not typical. If your role is eligible for a sign-on bonus, the bonus program that is approved and in place at the time of offer, is what will be honored.
EEO Statement

EEO/Vet/Disabled: All qualified applicants will receive consideration without regard to any lawfully protected status

Salary : $25 - $35