Medical Insurance Reimbursement Counselor - Full-time / Part-time

The Sr. Reimbursement Counselor will ensure the patient is registered, completes benefit verification and coordinates with physician/prescriber or prior authorization as needed. * Verifies drug card and/or major medical benefits ; Performs on-line claim tests. Investigates /brings resolution to on-line insurance rejections ; Accurately assigns proper payer for all patient coverage requests * Determines which potential coverage components of insurance plans (Rx, medical, DME, home health, etc) are appropriate provisions to cover the therapy as well as differentiate coverage by site of service (hospital, home or office). * Identifies/confirms pricing/reimbursement for patients &/or health care providers. Research payers to identify existing contracts, determine if particular specialty products are covered by a contract or coverage policy, & determine the best step is to take if no coverage policy is in place. Options for decisions will include adding product to an existing policy, seeking avenue for a new policy, entering into case by case agreements. * Defines which specialty pharmacy provider should dispense on particular cases taking into consideration contractual and other defined operational rules. Uses good judgment to determine when it is appropriate to aggressively pursue Assignment of Benefits (AOB) as requested by the treating physician. * Obtains authorizations for full scope of billable therapy (drug/supplies/training/etc.) based on the specific clinical use for that patient; confirm authorizations in writing. Define scope of authorization (medical necessity/specific dosing/pricing); conform to all requirements in order for authorizations to be kept current. Define claim submission requirements including method of submission (electronic/paper), format, codes, wording, etc. unless otherwise defined by payer. Facilitate agreements with insurance case managers. Define and obtain any medical information required by an insurer.
The Reimbursement Case Advocate (SRC) is responsible for acting on behalf of a manufacturer, to provide additional support services including but not limited to the following: handling inbound/outbound calls, processing insurance verification requests including on-line verification of pharmacy benefits, prior authorizations & appeals, managing referrals sent to other specialty providers & processing general product /support service inquiries. The Reimbursement Case Advocate (RA) will interact directly with key endocrinologists' offices & manage relationships as well as casework. They develop working relationships with office staff, provide patient casework, & facilitate all aspects of the reimbursement process for enrolled patients. The critical component of this role is the ability to effectively interface with Health Care Providers & office staff to pursue patient reimbursement cases while learning & documenting payer preferences & trends specific to geographical regions that impact current & future patient casework. Reimbursement Advocates must have a high degree of understanding of the office environment, HIPAA requirements, unique site or institution requirements & a deep understanding of office preferences in working with third party reimbursement staff. The position will also act as a semi-sales rep to inquire as to other services we can assist them with applying an understanding of product, therapeutic class & reimbursement process to be recognized as an expert in assisting patients with all aspects of growth hormone therapy. They will need to explain the medical need to the insurer for specific therapy as ordered by physicians/supported by medical documentation & ability to explain/provide resources about the therapy itself. This includes summarizing the differences between a clinically unique therapy & other drugs used to treat the diagnosis & provide insight to the payer as to why this therapy is typically prescribed.

The top 3 qualities that Shire looks for are:
Heatlhcare/Pharmacy experience
1. Strong Communication Skills
2. Strong Attention to Detail
3. Strong Problem Solving Ability

About Aerotek: Aerotek, headquartered in Hanover, Md., is a leading provider of technical, professional and industrial staffing services. Established in 1983, Aerotek is an operating company of Allegis Group, the largest provider of staffing services in the U.S. Aerotek operates a network of more than 200 non-franchised offices throughout the U.S., Canada and Europe. For more information, visit aerotek.com. Aerotek is acting as an Employment Agency in relation to this vacancy.