Reimbursement Specialist

At Johnson & Johnson, we believe health is everything. Our strength in healthcare innovation empowers us to build a world where complex diseases are prevented, treated, and cured, where treatments are smarter and less invasive, and solutions are personal. Through 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 humanity. Learn more at https://www.jnj.com

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

Our expertise in 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 https://www.jnj.com/innovative-medicine

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

Purpose

The Reimbursement Specialist (RS) is a professional role that handles payer inquiries, manages benefit investigations to determine patient eligibility and coverage, and addresses coverage challenges. This role serves as the main contact for payers and collaborates cross-functionally to support the patient service program.

Responsibilities

• Assess and analyze patient benefits in coordination with internal program operations, insurance providers, and specialty pharmacy liaisons.
• Work independently to complete assigned work in accordance with Standard Operating Procedures and defined service levels to review benefit verification process, resolve coverage challenges, and answer inquiries.
• Use high-level problem-solving skills to research cases and resolve independently using creativity, innovation, and professional judgement to make sound decisions.
• Maintain frequent phone contact with payers to gather all necessary information related to case/patient information, insurance coverage, prior authorization (PA) and appeals processing.
• Efficiently process patient and prescriber requests to accelerate access to therapy.
• Serve as expert on payer trends, product access, and reporting reimbursement insights and/or delays, i.e., denials or delays.
• Frequently communicate with program management on new insurance requirements and trends.
• Collaborate with internal & external stakeholders by providing reimbursement information as needed
• Maintain accurate, 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 diploma or equivalent.
• Minimum of 2 years of experience in case management or insurance roles preferably within a pharmacy, HUB, or healthcare setting.
• Experience using an outbound calling platform to make external calls
• Ability to independently manage case load, prioritize work, and use time management skills to meet service level agreements
• Ability to efficiently navigate multiple screens and systems to perform work.
• Ability to work assigned 8 hr shift 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

• Undergraduate Degree
• Understanding of plan types – Government, Commercial, Medicaid, VA, Fed
• Knowledge of insurance structure (ex PBM’s, major medical plans, co-pay assistance /cards)
• Working Knowledge of Third-Party and other Foundation programs
• Basic understanding of Co-Pay Assistance
• Understanding of HUB patient journey, workflow, and triage is a plus.
• Possess a strong understanding of biologic/specialty pharma market and patient access challenges
  
  

Johnson & Johnson is an 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 federal, state or local law. We actively seek qualified candidates who are protected veterans and individuals with disabilities as defined under VEVRAA and Section 503 of the Rehabilitation Act.

Johnson & Johnson is committed to providing an interview process that is inclusive of our applicants’ needs. If you are an individual with a disability and would like to request an accommodation, external applicants please contact us via https://www.jnj.com/contact-us/careers, internal employees contact AskGS to be directed to your accommodation resource.

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