The Reimbursement Specialist is a pivotal position requiring excellent communication skills, independent judgment, and ability to interact with private, state and federal payer representatives, fiscal intermediaries, case managers, pharmacy partners and nufactor field personnel in the role of coordinating reimbursement from product dispensing through to completion and final resolution of the payment cycle.
Incumbent shall possess basic knowledge of reimbursement principles as well as the structure of various private, federal and state payer entities and the specific program issues related to each.
Essential Functions and Duties
Submit and/or follow-up on payer claims. This may include; primary, secondary, tertiary claims and/or patient statements. Verify accuracy of payments according to the payer’s fee schedule.
Possess a basic understanding and ability to audit accounts receivables: analysis of payments, contractual discounts and/or adjustments, bad debt, recoupments, refunds and the credit/debit function.
Draft professional, concise cover letters, appeals and correspondence. This may include provider dispute forms, re-openings, reconsiderations, and various levels of appeals as necessary during the collection process.
Resolution of credit balances. This may include revenue adjustments, balance transfers, recoupments and/or refunds.
Clearly and accurately document all collection efforts within the AR system. Complete and submit monthly claim status reports.
Promptly inform management of reimbursement rates, changes, and/or issues which may directly affect nufactor receivables.
Maintain reimbursement records in compliance with nufactor policies & procedures.
Attend and participate in departmental meetings. Continuously strive to improve processes and service quality to internal and external customers.
Attend pertinent job-related trainings and educational seminars.
Conduct special projects as requested by management.
Supports all reimbursement activities related to a revenue base representing approximately $200 million per year and a projected DSO of less than 40 days.
Adheres specifically to all company policies and procedures, Federal and State regulations and laws.
Display dedication to position responsibilities and achieve assigned goals and objectives.
Represent the Company in a professional manner and appearance at all times.
Understand and internalize the Company’s purpose; Display loyalty to the Company and its organizational values.
Display enthusiasm and dedication to learning how to be more effective on the job and share knowledge with others.
Work effectively with co-workers, internal and external customers and others by sharing ideas in a constructive and positive manner; listen to and objectively consider ideas and suggestions from others; keep commitments; keep others informed of work progress, timetables, and issues; address problems and issues constructively to find mutually acceptable and practical business solutions; address others by name, title, or other respectful identifier, and; respect the diversity of our work force in actions, words, and deeds.
Comply with the policies and procedures stated in the Injury and Illness Prevention Program by always working in a safe manner and immediately reporting any injury, safety hazard, or program violation.
Ensure conduct is consistent with all Compliance Program Policies and procedures when engaging in any activity on behalf of the company. Immediately report any concerns or violations.
Other duties as assigned
Education, Knowledge, Skills and Experience
High school diploma or equivalent required.
Basic knowledge medical reimbursement principles.
Intermediate to advanced Microsoft Office skills. Basic to intermediate understanding of Internet technologies, including payer portals.
Three (3) years health care related experience i.e. DME, home care, medical insurance, or medical case management.
Pharmacy or home infusion experience preferred.
Excellent verbal and written communication skills, along with the ability to interact effectively with customers, coworkers, and all levels of management.
Ability to effectively communicate with all levels of personnel within the payer realm, including proficiency in accessing the appropriate personnel to resolve problem claims.
Ability to make independent judgments and work with minimal supervision.
Strong organizational skills and detail oriented with the ability to manage multiple assignments and responsibilities. Ability to prioritize work, work effectively, and maintain expected productivity.
Ability to exercise discretion and maintain confidentiality to the level of required HIPAA standards.
Vision, hearing, speech, movements requiring the use of wrists, hands and/or fingers. Must have the ability to view a computer screen for long periods and the ability to sit for extended periods. Must have the ability to work the hours and days required to complete the essential functions of the position, as scheduled. Must have the ability to lift and maneuver items of at least 20 lbs. Working condition include normal office setting.
Learning, thinking, concentration and the ability to work under pressure, particularly during busy times. Must be able to pay close attention to detail and be able to work as a member of a team to ensure excellent customer service. Must have the ability to interact effectively with co-workers and customers, and exercise self-control and diplomacy in customer and employee relations’ situations. Must have the ability to exercise discretion as well as appropriate judgments when necessary. Must be proactive in finding solutions
FFF Enterprises is an EEO/AAP employer; all business decisions (employment, promotions, compensation, etc.) are made without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, gender identity, or any other legally protected status. FFF Enterprises promotes an equal employment opportunity workplace which includes reasonable accommodation consideration of otherwise qualified disabled.
The above statements are intended to describe the general nature and level of work being performed by the incumbent assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and/or skills required of all personnel so classified.
The undersigned employee acknowledges receipt of the Job Description for the employee’s position and understands the essential functions, responsibilities and qualifications of the position. Furthermore, the employee acknowledges that this Job Description does not include all of the essential functions of this position, and that these essential functions may change as deemed necessary by the manager.
About FFF Enterprises Inc. and nufactor Specialty Pharmacy
FFF Enterprises is the nations must trusted specialty distributor of plasma products, vaccines, biosimilars, and other specialty biopharmaceuticals and pharmaceuticals. Our partners include the largest and most influential GPO’s, servicing over 80% of United States hospitals and supplying the nations leading non-acute care sites. Our unprecedented programs unite manufacturers, GPO’s and hospital partners, resulting in cost-containment and more access to common and uncommon products.
Nufactor is the specialty pharmacy subsidiary of FFF Enterprises. It is dedicated to the chronic illness community, providing specialty products, in home infusions, and individualize patient care on a daily basis. Some of the services include 24/7 on call pharmacists, 24/7 on call infusion experts, Nursing services, patient and physician educational programs, patient advocates, and administrative services.