Fairview Health Services  Reimbursement Specialist-Pharmacy Services in Twin Cities, Minnesota

JobTitle Reimbursement Specialist-Pharmacy Services

Specialty Pharmacy

Location Fairview offices at Kasota

Department Pharmacy - Univ Cam

Hours per 2 weeks 80

Shift Day

Date Posted 04/25/2018

Job Number 18-72597

Job Description:

As a member of the pharmacy team, the Reimbursement Specialist uses strong customer service skills and knowledge of authorization and reimbursement practices to ensure patients fast, easy and appropriate access to pharmacy services.

The Reimbursement Specialist accepts and processes referrals, identifies payer sources, verifies benefit information and acquires initial authorization as needed to begin patient service or to determine denial of patient service. This position also follows up on pending unresolved coverage issues and claim denials and documents and communicates to appropriate providers and internal department's accurate authorization information on current or potential patients.

This position may also complete the patient intake process, schedule patient appointments and partner with care team and external resources to ensure efficient patient flow as assigned.

Job Expectations:

Using strong knowledge of insurance, pharmacy practice, revenue cycle and in accordance with department Standard Operating Procedures (SOPs) and any regulatory or compliance requirements:

Perform verification of insurance benefits, analysis and identify any potential coverage issues

Assure fast, easy access to pharmacy services while documenting accurate referral and reimbursement (payer) information, coordinating the intake and benefit authorization process

Assist in resolving problems with payers and provide information and expertise to other departments.

Partner with potential international and self-pay patients on any financial or service needs related to their care as assigned.

Serve as a resource to the affiliations, staff and physicians regarding Fairview's pharmacy services in assigned area. Assist with the coordination of services by communicating effectively and in a timely manner with others.

Maintain current knowledge of payer requirements and general admitting practices including use of on-line verification applications and initial and ongoing training.

Other administrative responsibilities as assigned.

Job Qualifications:

Required Experience:

2 years of experience in a pharmacy setting or with revenue cycle, health insurance or benefit experience using an enterprise software system in healthcare or insurance organization.

Preferred Education:

Baccalaureate degree in business, communications, social work or health care.

Preferred Experience:

2 years of revenue cycle, health insurance or benefits experience using an enterprise software system in the assigned clinical area or service line of a complex healthcare organization. Knowledge of ICD9 and ICD10 coding.

Preferred License/Certification/Registration:

Pharmacy certification with the Pharmacy Technician Certification Board. If Minnesota Board of Pharmacy registration on or after 1/1/2013, must have a certificate of completion from a MNBOP approved employer based or vocational/technical training program.

About Fairview Health Services

Fairview Health Services (fairview.org) is an award-winning, nonprofit health system providing exceptional care across the full spectrum of health care services. Joined by HealthEast in June 2017, Fairview is one of the most comprehensive and geographically accessible systems in the state, with 11 hospitals—including an academic medical center and long-term care hospital—serving the greater Twin Cities metro area and north-central Minnesota.

Its broad continuum also includes 56 primary care clinics, specialty clinics, senior living communities, retail and specialty pharmacies, pharmacy benefit management services, rehabilitation centers, counseling and home health care services, medical transportation, an integrated provider network and health insurer PreferredOne. In partnership with the University of Minnesota, Fairview’s 32,000 employees and 2,400 affiliated providers embrace innovation to drive a healthier future through healing, discovery and education.

EEO/AA Employer/Vet/Disabled

All qualified applicants will receive consideration without regard to any lawfully protected status.