Document/Reimbursement Resource Specialist - Pyramid Consulting : Job Details

Immediate need for a talented Document/Reimbursement Resource Specialist. This is a 12+ months contract opportunity with long-term potential and is located in Cambridge, MA (Hybrid). Please review the job description below and contact me ASAP if you are interested.

Job ID: 24-48296

Pay Range: $30 - $35/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:

• Assist with the verification of insurance coverage policies and benefit details through direct contact with medical insurance providers with prompt communication of accurate information to facilitate the initiation and ongoing continuation of treatment
• Research and identify insurance company prior authorization processes and provide necessary documents and requirements to Case Management team members
• Re-verify insurance benefits and coverage as needed to assist the Case Management Team with prompt service for Patients and Facilities.
• Assist case management team in the resolution of co-pay claim issues related to Client Co-Pay Assistance Program
• Coordinate within the functional Reimbursement Support Specialist team to ensure efficient assignment and distribution of tasks from the shared work queue
• Maintain up-to-date knowledge of the reimbursement process, healthcare policy, insurance plans, payer trends, financial assistance programs, and related resources
• Complete daily documentation of all interactions and input accurate data, which includes inbound phone calls, prescription information, insurance and PBM information, coverage approvals and/or denials, prior authorization information and ongoing coverage requirements in iCare Database while maintaining compliance with HIPAA and other applicable healthcare and privacy regulations
• Establish proficiency and full understanding of the Client Rare Blood Disorders Patient Support Services Customer Relationship database including understanding of data elements, case statuses and outcomes, and documentation requirements
• Receive and report all Adverse Events and Product Technical Complaints to Pharmacoviligence in accordance with Client, Rare Blood Disorders and FDA rules and regulations

Key Requirements and Technology Experience:

• Key skills; Reimbursement , medical billing, Health Insurance
• Reimbursement Resource Specialist
• Bachelor's degree required
• 4-5 years' experience in health insurance reimbursement, medical billing, or equivalent applicable work experience
• Effective communication, problem-solving and negotiation skills required.
• Ability to think critically and problem solve to address customer needs.
• Ability to work collaboratively and independently in a fast-paced environment
• Experience working in a high- volume patient services program preferred.
• Experience with Salesforce CRM preferred.
• Proficient with Microsoft Office, Word, Excel, and PowerPoint
• Ability to be on-site 2-3 days per week.

Our client is a leading Healthcare Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, colour, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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