Medicaid Analyst / Claim Analyst
REIMBURSEMENT EXPERTISE (NATIONAL & REGIONAL LEVELS):
* Establish and maintain a strong understanding of Client Renal's product reimbursement though Medicare Part D, state Medicaid, and government and commercial prescription drug plans.
* Keep current on all available Client Renal Patient Assistance Programs, State Pharmacy Assistance Programs (SPAPs), and government and independently sponsored alternative funding programs.
* Perform Verification of Benefits (VOBs) for patients who are clinically appropriate for Client Renal products and enter information into Sales Logix database in a timely and accurate manner.
* Provide appropriate information to patients, their families, physicians, health care professionals, and insurance carriers on the coverage and benefits of Client Renal products.
* Facilitate Prior Authorizations, Formulary Exceptions, and/or other step edit requirements for Client Renal Products.
* Collaborate with Renassist team members, professionals, and insurance companies to troubleshoot and resolve reimbursement-related issues.
RELATIONSHIP BUILDING document all pertinent information on callers into SalesLogix database.
* Interact via phone with pharmacies, insurance companies, professionals, and Renal Business Unit colleagues.
* Partner with internal Renassist counterparts to effectively manage regional reimbursement needs.
* Limited travel may be required for National, Zone, and Regional meetings.
* Bachelor's degree and 0-3years of experience.
* Working knowledge of insurance benefits.
* Experience working in a team environment.
* Ability to work independently.
* Strong relationship building skills with external customers.
* Ability to overcome product access & reimbursement obstacles to directly impact patient care.
* Effective workload management.
* Ability to multitask and prioritize tasks independently.
* Exceptional customer service.
* Strong problem solving & decision making skills.