Reimbursement Specialist
Reimbursement Specialist (Contractor)
The Position:
Position requires working in the Portland office. Relocation/Sponsorship assistance will not be provided.
The Access Solutions Reimbursement Specialist investigates patient’s insurance benefits and obtains prior authorization information of Genentech products at the patient/family request. The Reimbursement Specialist reports to the Case Management & Reimbursement Supervisor and is an individual contributor.
Key Responsibilities/Accountabilities:
- Investigate patient’s insurance benefits.
- Identify network providers, provider restrictions, and co-pays as needed.
- Document requirements for prior authorization and medical review process.
- Document activities appropriately in progress notes.
- Pursue product coverage for patients in accordance with the payer’s authorization requirements within the departments established performance criteria.
- Maintain payer profiles by recording payer specific data promptly into the system.
- Convey outcomes of benefit investigation to internal contacts (i.e. case managers).
- Learn processes for multiple products and effectively apply learnings to provide effective reimbursement services.
- Conduct all work in a compliant manner.
- Consult with team members on an as needed basis.
- Periodic mandatory overtime throughout the year is required in Access Solutions Operations. This may include, but is not limited to, high referral season (Blizzard, Enrollment renewal), new product or system launches, new line extensions, or any unexpected surge in volume or backlog situations. May include weekends as needed.
Competencies:
- Communication
- Inspiring and Influencing
- Teamwork and Collaboration
- Achieving Results
Recommended Skills and Experiences:
- Bachelor’s degree is preferred or equivalent experience.
- A minimum of 3 years reimbursement experience is preferred.
- Knowledge of managed care industry including government payers.
- Proficiency in all aspects of reimbursement (i.e., benefit investigations, payer reimbursement policies, regulatory and administrative rules).
- Understands reimbursement/funding resources and how to access these resources.
- Excellent investigational and analytical skills with a proven ability to communicate effectively in both written and verbal format.
- Ability to work collaboratively in a team structure and responsibly delegate next steps to appropriate team members.
- Demonstrates effective problem solving and excellent customer service.
- Exceptional attention to detail and ability to prioritize tasks.
- Must be able to follow written Standard Operating Procedure.
Who We Are:
A member of the Roche Group, Genentech has been at the forefront of the biotechnology industry for more than 40 years, using human genetic information to develop novel medicines for serious and life-threatening diseases. Genentech has multiple therapies on the market for cancer & other serious illnesses. Please take this opportunity to learn about Genentech where we believe that our employees are our most important asset & are dedicated to remaining a great place to work.
Genentech is an equal opportunity employer & prohibits unlawful discrimination based on race, color, religion, gender, sexual orientation, gender identity/expression, national origin/ancestry, age, disability, marital & veteran status. For more information about equal employment opportunity, visit our Genentech Careers page.