Reimbursement Specialist – Medical Billing/HUB Services – Remote
As the only global provider of commercial solutions, IQVIA understands what it takes to deliver nationally and internationally. Our teams help biopharma get their medicines to the people who need them. We help customers gain insight and access to their markets and ultimately demonstrate their product’s value to payers, physicians and patients. A significant part of our business is acting as the biopharma’s sales force to physicians or providing nurses to educate patients or prescribers. With the right experience, you can help deliver medical breakthroughs in the real world.
AllCare Plus Pharmacy, an IQVIA company, is seeking a Reimbursement Specialist! Responsible for the daily evaluation and collaboration of identifying and addressing departmental needs and priorities. Is responsible for proper completion of all daily tasks in a timely fashion while ensuring compliance with all standard operating procedures, cross functionally. This is a remote position.
Hours: Must be available between 8am-8pm EST
The information contained herein is intended to be an accurate reflection of the duties and responsibilities of the individuals assigned to this position. They are not intended to be an exhaustive list of the skills and abilities required to do the job. AllCare Plus Pharmacy reserves the right to revise the job or to require that other or different tasks be performed as assigned.
Work closely with the Program Sr. Director, Program Director, and the Program Managers to evaluate departmental needs and priorities Schedule and delegate projects amongst team members, as needed, to address departmental priorities Assist with projects or assignments as directed by Directors to support departmental priorities Track, assist in research, trend, and communicate issues identified among staff during projects Work collaboratively with cross functional teams to ensure all updates made by the Reimbursement Coordinator(s) and/or CM(s) that may impact other functional areas are communicated to all impacted persons/teams in a timely manner Work with call center leadership to identify improvements and provide plan of action proposals Consistently meet excellent quality requirements and follow all required interaction components as outlined in departmental SOP’s and protocols Maintain strong working knowledge of insurance carriers and third-party billing requirements Assist with the creation and review of SOPs Identify and quantify payor issues and proposed solutions
Associate’s Degree or equivalent previous employment experience Minimum 3 years’ experience in pharmacy, healthcare, medical billing, insurance verification or similar experience Minimum of 1 year working cross functionally among billing & reimbursement and/or HUB services departments Exceptional communication and facilitation skills, both verbal and written, with a proven ability to communicate to all levels of the organization Data entry skills and ability to type 30wpm+
Experience verifying insurance eligibility and coverage including but not limited to: benefits, pre-certification and referrals, reimbursement Previous supervisory and training experience
Business Skills and Knowledge
- General Management
Demonstrate analytic and problem solving skills, and understand the impact of individual
decisions on other parts of the organization and the environment.
- Risk management
Knowledge of liability and compliance regulation, the ability to employ strategies to
mitigate risk, avoid malpractice and plan for disasters.
- Quality improvement
Application of techniques that continually improve the quality of care provided, patient
safety, organizational performance, and the financial health of the organization.
Knowledge of the Health Care Environment
- Health Care Systems and Organizations
Demonstrate an understanding of how the various components of the health care
system is organized and financed, and how they interact to deliver medical and health
- The Patient’s Perspective
Understand the patient experience, demonstrate a commitment to patients’ rights and
responsibilities, and ensure that the organization provides a safe environment for
patients and their families.
Communication and Relationship Management
- Relationship Management
The ability to build and maintain relationships with internal as well as external
stakeholders that are anchored in trust and where decision-making is shared.
- Communication Skills
Be able to utilize verbal, written and presentation skills to communicate an
organization’s mission, vision, values and priorities to diverse audiences.
- The ability to inspire individual and organizational excellence, create and attain a shared vision
and successfully manage change to attain the organization’s strategic ends and successful
- The ability to align personal and organizational conduct with ethical and professional standards
that include a responsibility to the patient and community, a service orientation, and a
commitment to lifelong learning and improvement.
AllCare Plus Pharmacy, Inc. is an Equal Opportunity Employer that complies with applicable state and local laws governing nondiscrimination in employment. We provide equal employment opportunities to all employees and applicants without regard to race, color, religion, sex, national origin, age, disability or genetics.
IQVIA is a leading global provider of advanced analytics, technology solutions and clinical research services to the life sciences industry. We believe in pushing the boundaries of human science and data science to make the biggest impact possible – to help our customers create a healthier world. Learn more at https://jobs.iqvia.com
We are committed to providing equal employment opportunities for all, including veterans and candidates with disabilities. https://jobs.iqvia.com/eoe
IQVIA’s ability to operate and provide certain services to customers and partners necessitates IQVIA and its employees meet specific requirements regarding COVID-19 vaccination status.https://jobs.iqvia.com/covid-19-vaccine-statusThe potential base pay range for this role is $23.00 per hour. The actual base pay offered may vary based on a number of factors including job-related qualifications such as knowledge, skills, education, and experience; location; and/or schedule (full or part-time). Dependent on the position offered, incentive plans, bonuses, and/or other forms of compensation may be offered, in addition to a range of health and welfare and/or other benefits.
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