HealthCare Financial Reimbursement Analyst

AmeriPharma; Laguna Hills (CA); Presencial; USD 70.000 - 90.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical coverage

Dental coverage

Vision coverage

Life insurance

401k

Paid time off

Career growth opportunities

Casual Fridays

Descripción de la vacante

AmeriPharma in Laguna Hills, CA, is seeking a detail-oriented specialist to support revenue integrity and patient retention financial reviews. You will analyze payer fee schedules, patient benefits, and reimbursement databases to improve cost-effectiveness and transparency for customers.

The role requires at least an associates degree and 2+ years in a specialty pharmacy setting, with strong organizational and communication skills, and proficiency in Microsoft Office.

Formación

• Associates degree required and two years of experience in a specialty pharmacy setting.
• Experience with payer reimbursement methodologies in healthcare revenue specialty reimbursement is required; Medicare Part B & D experience is a plus.
• Strong attention to detail, organizational skills, and ability to manage multiple tasks in a fast-paced environment.
• Excellent verbal and written communication skills; proficient with Microsoft Office and data entry.

Responsabilidades

• Support reimbursement review and determination within specialty operations.
• Review new referrals for cost-effectiveness using payer fee schedules and contracted rates.
• Generate ad-hoc profitability, cancellation, and performance reports.
• Educate patients on AmeriPharma products and available financial assistance options.
• Document patient interactions and insurance details in the EHR system; maintain HIPAA compliance.

Conocimientos

Attention to detail

Organizational skills

Communication skills

Multitasking

Microsoft Office

Data entry

Teamwork

Independent & collaborative work

Educación

Associates degree

Herramientas

Microsoft Office

Descripción del empleo

About AmeriPharma

AmeriPharma is a rapidly growing healthcare company where you will have the opportunity to contribute to our joint success on a daily basis. We value new ideas, creativity, and productivity. We like people who are passionate about their roles and people who like to grow and change as the company evolves.

AmeriPharma’s Benefits

• Full benefits package including medical, dental, vision, life that fits your lifestyle and goals
• Competitive total rewards package
• Employee assistance program to assist with mental health, legal questions, financial counseling etc.
• Comprehensive PTO and sick leave options
• 401k program
• Plenty of opportunities for growth and advancement
• Company sponsored outings and team-building events
• Casual Fridays

Job Summary

The role supports the Director of Revenue Integrity and Director of Patient Retention in the financial review process, ensuring cost-effectiveness by analyzing new referrals, existing patients’ health plan fee schedules, and other reimbursement databases. Key responsibilities include evaluating payer reimbursement methodologies, reviewing patient insurance benefits, and educating patients about available drug brands and copayment assistance programs. This position is designed to enhance patient onboarding and ongoing care by ensuring new and existing patients are informed of all available healthcare benefit options.

Schedule Details

Location: Laguna Hills, CA. (This is an on-site position; remote work is not an option at this time.)

Schedule: Monday–Friday, with hours scheduled anytime between 6:30 a.m. and 5:00 p.m., based on department and leadership needs.

Duties and Responsibilities

• Assist with the reimbursement review and determination process within specialty operations.
• Review new referrals to ensure cost-effectiveness based on payer fee schedules and/or contracted rates,utilizing both In/Out-of-Network benefits from the patient’s health plan.
• Generate ad-hoc reports on profitability, cancellations, and other relevant categories.
• Educate and guide patients on AmeriPharma's products and services, including financial assistance options when applicable.
• Provide clear explanations of healthcare insurance benefits, including coverage details, copayments,deductibles, and network restrictions.
• Accurately document patient interactions, insurance details, and other relevant information in the electronichealth record (EHR) system.
• Maintain confidentiality and comply with HIPAA and all applicable regulatory requirements.
• Strong patient care and customer service skills.
• Strong business acumen, problem-solving, and analytical skills.
• Knowledge of medical and pharmacy reimbursement methodologies.
• Familiarity with various types of health insurance benefits and patient access/copayment assistanceprograms in the marketplace.
• Additional duties and responsibilities in different areas of the department on an as-needed basis or determined by management.
• Foster a culture of accountability, integrity, collaboration, and service excellence.

Required Qualifications and Education

• Associates degree.
• Minimum of 2 years of experience in specialty pharmacy setting
• Minimum of 2 years of experience with payer reimbursement methodologies within the healthcare revenue specialty reimbursement industry; experience with Medicare Part B & D.
• Strong attention to detail and organizational skills.
• Ability to manage multiple tasks and meet deadlines in a fast-paced environment.
• Effective verbal and written communication skills.
• Proficient in Microsoft Office applications and basic data entry functions.
• Ability to work independently and collaboratively within a team environment.

Preferred Qualifications

• Experience in specialty pharmacy, home infusion, medical billing, or copay assistance programs strongly preferred.

AmeriPharma’s Mission Statement

Our goal is to achieve superior clinical and economic outcomes while maintaining the utmost compassion and care for our patients. It is our joint and individual responsibility daily to demonstrate to outpatients, prescribers, colleagues, and others that We Care!

Physical Requirements

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is continuously required to sit and talk or hear. The employee is occasionally required to stand; walk; use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; and stoop, kneel, crouch or crawl. The employee must regularly lift and/or move up to 25 pounds and occasionally lift/or move up to 30 pounds. Specific vision abilities required by this job include close vision, peripheral vision, depth perception and the ability to adjust focus.

EEO Statement

The above statements are intended to describe the work being performed by people assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties and skills required. The duties and responsibilities of this position are subject to change and other duties may be assigned or removed at any time. AmeriPharma values diversity in its workforce and is proud to be an AAP/EEO employer. All qualified applicants will receive consideration for employment without regard to race, sex, color, religion, sexual orientation, gender identity, national origin, age, protected veteran status, or based on disability or any other legally protected class.