RCM/OPH Drug Reimbursement Specialist

EyeCare Partners is the nation’s leading provider of clinically integrated eye care. Our national network of over 300 ophthalmologists and 700 optometrists provides a lifetime of care to our patients with a mission to enhance vision, advance eye care and improve lives. Based in St. Louis, Missouri, over 650 ECP-affiliated practice locations provide care in 18 states and 80 markets, providing services that span the eye care continuum. For more information, visit www.eyecare-partners.com.

Job Title: Drug Reimbursement Specialist

Must reside in the following states: AL, AZ, FL, GA, IL, IN, KS, KY, MI, MN, MO, NC, NJ, OH, OK, PA, TX, VA

JOB SUMMARY

Drug Reimbursement Specialists are responsible for communicating and working with patients to identify methods of payments. Works directly with insurance companies, drug assistance programs, and medical billing staff to manage billing and reimbursements for injectable medications. 

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Be proactive in running appointment reports to determine which patients will need a new prior authorization one to two weeks in advance

• Keep authorization alerts in both EPM and EHR up to date

• Be knowledgeable of all insurance plans, benefits, and coverage

• Be available in the clinic during injections to assist in any insurance changes, billing questions or new patients requiring new assistance programs or authorizations.

• Be available for patients to contact for assistance fund billing questions, assistance program information, enrollment, and re-enrollment

• Have the knowledge to obtain and provide a benefit investigation to the requesting physician • Have the customer service skills to communicate with the patient in a way that the elderly patient can understand

• Have the knowledge of insurance plans and which plans require step therapy-step edits

• Keep communication with drug representatives regarding insurance changes and authorization requirements

• Keep up to date on which doses of medication can be used with which diagnosis

• Be able to fill out prescription information on all authorization forms and understand which chart notes are sufficient for authorization requests

• Task Dr’s and scribes to make corrections to chart notes that are not sufficient for authorization request

• Keep up to date on prescriptions with the specialty pharmacy for free medications

• Knowledge of which insurance plans require their patients medication to be shipped from the preferred specialty pharmacy instead of buy and bill medications

• Coordinate shipments every month for free drug patients • Document when shipments will be delivered and make sure they are put into refrigeration in a timely manner.

• Adheres to all safety policies and procedures in performing job duties and responsibilities while supporting a culture of high quality and great customer service.

• Performs other duties that may be necessary or in the best interest of the organization

EDUCATION & CERTIFICATION REQUIREMENTS

• High school diploma or equivalent required

EXPERIENCE REQUIREMENTS

• Previous medical office experience preferred; previous ophthalmic experience strongly preferred.

Knowledge, Skills and Abilities Requirements

• Professional in appearance and actions • Logical and Critical thinking skills

• Customer-focused with excellent written, listening and verbal communication skills

• Enjoys learning new technologies and systems

• Detail oriented, professional attitude, reliable 

• Exhibits a positive attitude and is flexible in accepting work assignments and priorities

• Meets attendance and tardiness expectations

• Management and organizational skills to support the leadership of this function 

• Ability to follow or provide verbal & written instructions with sufficient grammar and spelling skills to avoid mistakes or misinterpretations

• Interpersonal skills to support customer service, functional, and team mate support need

                   o Able to communicate effectively in English, both verbally and in writing 

• Ability for basic to intermediate problem solving, including mathematics

• Basic to intermediate computer operation o Proficiency with Microsoft Excel, Word, and Outlook

• Specialty knowledge of systems relating to job function

• Knowledge of state and federal regulations for this position; general understanding of HIPAA guidelines

Location/Work Environment:

For remote team members, HIPAA compliant home office environment. Ability to work in a remote environment while performing required duties and remaining patient focused. Able to work varying shifts including early mornings/evenings to attend meetings and cross training or support other initiatives.

EyeCare Partners is an equal opportunity/affirmative action employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.   Please do not contact the office directly – only resumes submitted through this website will be considered

NOTE:  Job descriptions are intended to be accurate reflections of those principal job elements essential for making fair pay decisions about jobs. Nothing in this job description restricts management right to assign or reassign duties and responsibilities to this job at any time.