Reimbursement Specialist

Robert B Green Campus; San Antonio (TX); On-site; USD 32,000 - 43,000; Full time

Job summary

Robert B Green Campus seeks a Pharmacy Technician to identify and enroll patients into drug assistance programs, tracking eligibility and drug shipments. The role involves coordinating with pharmacy staff, hospital administration, medical staff, and patient assistance programs, ensuring accurate documentation and seamless enrollment processes.

Responsibilities include resolving insurance denials, coordinating 3rd party billing, and expanding computerized databases to support program enrollment.

Qualifications

• Texas State Board of Pharmacy registration is required.
• CPhT certification is recommended.
• Three years in medical/pharmacology field covering project coordination, database/spreadsheet management, and/or medical insurance billing.

Responsibilities

• Enroll indigent and under-insured patients into drug assistance programs.
• Monitor eligibility status and document shipments in tracking system.
• Coordinate 3rd party billing and resolve insurance denials with Outpatient Pharmacy Supervisor.
• Facilitate resolution of insurance denial referrals and communicate with staff and patients.
• Maintain databases to support patient enrollment in assistance programs.

Skills

Interpersonal communication

Independent work

Analytical skills

Project coordination

Problem solving

Education

Texas State Board of Pharmacy registration

Certified Pharmacy Technician (CPhT) recommended

Tools

Database software

Spreadsheet software

Basic programming

Job description

POSITION SUMMARY/RESPONSIBILITIES

Identifies and enrolls indigent and under-insured patients into drug assistance reimbursement programs which provide drug replacement and reimbursement compensation. Monitors continued eligibility status and documents drug shipments received in computerized tracking system. Serves as a resource in facilitating resolution of insurance denial referrals. Communicates effectively with pharmacy, hospital administration, medical staff, patients and personnel in the patient assistance programs using verbal and written interpersonal communication skills. Requires ability to work independently and coordinate assigned projects efficiently. Effectively utilizes problem-solving ability, significant interpersonal contact and concentration abilities, analytical skills and in depth knowledge of computer software. Coordinates all information regarding patients enrolled in assistance programs for drug therapies using various computer software programs. Creates, expand and maintains computerized databases to support patient enrollment in assistance programs and tracks case specific assistance provided in response to reimbursement denials. Conducts patient interviews and conveys reimbursement denial potential to patient and medical staff. Reviews all outpatient 3rd party rejections and assists the patient in resolving the problem. Coordinates 3rd party billing, problems with eligibility, rejections, etc. with the Outpatient Pharmacy Supervisor and the Pharmacy Billing Section.

EDUCATION/EXPERIENCE

Texas State Board of Pharmacy registration required. National Certification as a Certified Pharmacy Technician (CPhT) is recommended. Three years experience in a medical or pharmacology related field to include project coordination; database/spreadsheet development and management; and/or application programming; processing and overseeing medical insurance billing and reimbursement cost capture. Must have demonstrated independent judgment.