Reimbursement Specialist

South San Francisco, CA | Contract

Post Date: 01/10/2018 Job ID: 12407 Industry: Clinical & Scientific

Bayside Solutions is seeking a Reimbursement Specialist I to be part of our Client’ s team in South San Francisco. This is an opportunity to work with a local Biotechnical company focusing on the discovery, development, manufacturing and commercialization of medicines to treat patients with serious or life-threatening medical conditions.

Our Company Bio:  Bayside Solutions was founded in 2001, Bayside was recognized as one of the fastest growing professional staffing companies in Northern California. The numbers tell the story: We have close to a 100% client retention rate, 700% growth in four plus years and over 95% repeat business. Our dedication to building partnership relationships with both our clients and our recruits is the key to our phenomenal success.

You can find additional information on our company website

Reimbursement Specialist I

Job Benefits:
  • An opportunity to join a patient-focused organization that is driven to develop and commercialize novel drugs for treating rare diseases.
  • Work for a company that is local to the bay area and recognized as a leader of innovation.  
  • Competitive compensation commensurate with experience.
  • This position is eligible for medical, vision, dental benefits, paid sick time, and 401K.

Summary of Responsibilities:
  • Investigates patients’ insurance benefits.
  • Identifies network providers, provider restrictions, co-pays as needed.
  • Documents requirements for prior authorization and medical review process.
  • Documents activities appropriately in progress notes.
  • Pursue product coverage for patients in accordance with the payers’ authorization requirements within the departments established performance criteria.
  • Maintains payer profiles by recording payer specific data promptly into the system.
  • Convey outcomes of benefit investigation to internal contacts (i.e. case managers).
  • Ability to learn processes for multiple products and effectively apply learnings to provide effective reimbursement services.
  • Conducts all work in a compliant manner.
  • Consults with team members on an as needed basis.
  • This position requires some flexibility in work shift.
  • Periodic mandatory overtime throughout the year is required. This may include, but is not limited to, high referral season, new product or system launches, enrollment renewals, new line extensions, or any unexpected surge in volume or backlog situations.
  • Workdays are M-F, but may include weekends as needed.

Required Qualifications:
  • Bachelor’ s Degree preferred.
  • A minimum of 3 years reimbursement experience preferred.
  • Proficient 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.
  • Knowledge of managed care industry including government payers.
  • 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 delegates next steps to appropriate team members.
  • Demonstrates effective problem solving and excellent customer service.
  • Exceptional attention to detail and ability to prioritize tasks.

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