Reimbursement Specialist I (10:30-7:00pm CST)

Lumicera; Madison (WI); On-site; USD 42,000 - 62,000; Full time

Benefits offered by this job

Health, Dental, Vision insurance

Paid time off

Parental leave

401K with company match

Adoption Assistance

Flexible Spending Account

Educational assistance

Referral bonus up to $750

Job summary

Lumicera Health Services is seeking a Reimbursement Specialist I to join our team in Madison, WI. You will monitor claims for accuracy, ensure patient billing data is correct in the pharmacy system, and support reimbursement activities across the team.

Responsibilities include handling questions, assisting in claim resolution, and maintaining thorough documentation. A background in pharmacy billing and HIPAA compliance is preferred.

Qualifications

• Experience with pharmacy, health plan or clinical insurance claims billing, benefit assessments, billing/claims documentation, or claims auditing.
• Ability to interact cooperatively with others and maintain professional conduct.
• Understanding of HIPAA and compliance programs is preferred.
• Strong documentation and reference information upkeep in patient profiles.

Responsibilities

• Monitor claims activity for accuracy and successful submission.
• Ensure patient billing information is correctly set up in pharmacy software.
• Participate in conferences and meetings related to reimbursement and billing.
• Respond to questions or complaints regarding reimbursement and/or billing.
• Collaborate with internal teams to review and resolve claim issues.
• Maintain accurate reimbursement reference information and copay assistance data.
• Document information, insurance, and prescriptions/orders in patient profiles.
• Adhere to all applicable laws and internal ethical standards.
• Perform additional duties as assigned.

Skills

Claims billing experience

Pharmacy payer knowledge

Customer service

Compliance awareness

Team collaboration

Education

High School Diploma or GED

Some college preferred

Pharmacy technician license or trainee license preferred

CPhT preferred

Job description

Overview

Lumicera Health Services is seeking a Reimbursement Specialist I to join our team!

Under direction from the Assoc. Manager, Specialty Pharmacy Services, Reimbursement Team Lead, and pharmacists in the Specialty Pharmacy, the Reimbursement Specialist I is primarily responsible for following standard operating procedures to obtain and process manufacturer copay assistance program reimbursement. The Reimbursement Specialist I shall have knowledge of billing procedures and work to reduce discrepancies, inaccuracy, and outstanding balances. The Reimbursement Specialist I may also assist in contacting patients with an outstanding balance to communicate billing options.

Is this you? Find out more below!

Responsibilities

How do I make an impact on my team?

• Responsible for ongoing monitoring of claims activity for accuracy and successful submission
• Responsible for ensuring that patient billing information is set up appropriately in the pharmacy software
• Participate, as necessary, in conferences and meetings related to reimbursement/billing
• Responds to employee/patient/client questions or complaints regarding reimbursement and/or billing
• Works with internal teams to review and resolve claim issues
• Maintains accurate reference information relating to reimbursement and copay assistance
• Responsible for accurate and thorough documentation of information, insurance and prescriptions/orders within the patient profile
• The Employee will act in accordance with all applicable federal and state laws and with the highest ethical standards that we consistently strive to achieve. Thus, legal and ethical compliance is an essential duty of each employee
• Other duties as assigned

Qualifications

What our team expects from you?

• High School Diploma or equivalent GED. Some college preferred
• CPhT preferred
• Pharmacy technician license or pharmacy technician trainee license is strongly preferred in states requiring pharmacy technician licensure
• Experience with pharmacy, health plan or clinical insurance claims billing, benefit assessments, billing/claims documentation, or claims auditing is preferred
• Participate in, adhere to, and support compliance program objectives
• The ability to consistently interact cooperatively and respectfully with other employees

What can you expect from Navitus?

• Top of the industry benefits for Health, Dental, and Vision insurance
• 20 days paid time off
• 4 weeks paid parental leave
• 9 paid holidays
• 401K company match of up to 5% - No vesting requirement
• Adoption Assistance Program
• Flexible Spending Account
• Educational Assistance Plan and Professional Membership assistance
• Referral Bonus Program - up to $750!

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Navitus Health Solutions is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, creed, sex, pregnancy, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, veteran status, or any other characteristic protected by law.

Equal employment opportunity, including veterans and individuals with disabilities.