reimbursement representative

Mercalis

<div>Overview:

**SHIFTS FOR THESE ROLES ARE (4)8A-5P, (4)9A-6P, (2) 10A-7P - ALL EST; ALL M-F.** 
Valeris is a fully integrated life sciences commercialization partner that provides comprehensive solutions that span the entire healthcare value chain. Formed by the merger of PharmaCord and Mercalis, Valeris&trade; revolutionizes the path from life sciences innovation to real-life impact to build a world in which every patient gets the care they need. Valeris works on behalf of life sciences companies to improve the patient experience so that patients can access and adhere to critical medications. Backed by proven industry expertise, a deep commitment to patient care, the latest technology, and exceptionally talented team members, Valeris provides the data and strategic insights, patient support services and healthcare provider engagement tools to help life sciences companies successfully commercialize new products. Valeris provides commercialization solutions to more than 500 life sciences customers and has provided access and affordability support to millions of patients. The company is headquartered in Morrisville, North Carolina and Jeffersonville, Indiana. To learn more about Valeris, please visit www.valeris.com.<div></div><div> 
As a Reimbursement Case Manager, you provide inbound and outbound phone support and serve as the primary contact for patients, caregivers, and providers. You will facilitate a collaborative process that gauges, coordinates, and monitors patient needs and appropriately facilitate a patient&rsquo;s journey utilizing services offered through the Patient Support Program on behalf of a manufacturer. The primary function is to provide unparalleled customer service to patients, caregivers and providers as a dedicated contact by coordinating resources, exchanging information and ensuring appropriate delivery of services. These services include handling the day-to-day activities within reimbursement services, such as daily interactions with healthcare insurance companies to verify the financial aspects of healthcare services to ensure patients have access to life saving treatments they need.</div>
Responsibilities:<div></div><div> 
<ul><li>
Reimbursement Case Managers may be regionally aligned and will serve as an expert on reimbursement, co-pay, foundation assistance, PAP issues, and other forms of available support and will be responsible for handling patient and healthcare provider interactions</li><li>
Serve as an advocate to patients regarding eligibility requirements, program enrollment, reimbursement process, affordability support, and general access for prescribed therapy</li><li>
Establish relationships, develop trust, and maintain rapport with patients, payers and healthcare providers</li><li>
Serve as direct point of contact to health care providers for ongoing support and relationship development by acquiring and delivering detailed information regarding a program and/or a patient</li><li>
Serve as a resource for patients and healthcare professionals to verify insurance coverage, medical billing, reimbursement process, and general access for complex pharmaceuticals</li><li>
Evaluate program enrollment forms for data integrity</li><li>
Responsible for insurance benefit investigations, and triage cases according to program standard operating procedures</li><li>
Follow program guidelines and escalate complex cases according to program policy, SOPs, Call Guides, and other program materials.</li><li>
Working case management system, documenting status/background in case notes, communicating patient benefits, assisting in the PA/Appeals process and like responsibilities</li><li>Ability to understand and explain benefits offered by all payer types including private/commercial and government (i.e., Medicare, Medicaid, VA and DOD)</li><li>Act as an assigned liaison to client contacts (e.g., regional contact for sales representatives), Program Management, other internal stakeholders and Healthcare Providers</li><li>
Maintain records in accordance with applicable standards and regulations to the programs/promotions</li><li>Provide unparalleled customer service while serving as a brand advocate and program representative; understands the importance of achieving quality outcomes and commit to the appropriate use of resources
</li><li>Works with the Program Manager, on a day-to-day basis to maintain open lines of communication and share awareness regarding patient status, prescriber feedback/satisfaction and program effectiveness</li><li>
Understand health and disease states of patients of the programs
</li><li>Maintains a high level of ethical conduct regarding confidentiality and privacy</li><li>
Help maintain team morale by consistently demonstrating positive attitude
</li><li>On time adherence to training deadlines for all corporate policies and procedures governing access to confidential data</li><li>Ensure all SOPs are followed with consistency</li><li>Conducts miscellaneous tasks or projects as assigned Identify and report pharmacovigilance information as required by client(s) (i.e., Adverse Events) &ndash; (specific to program/client requirements)
</li></ul></div> 
Qualifications:
<ul><li>Associate or Bachelor&rsquo;s degree preferred; or a minimum of 4 years of call center or customer service experience with progressive levels of responsibility within a service driven environment</li><li>
Ability to communicate effectively both orally and in writing</li><li>
Knowledge of medical insurance terminology and reimbursement/insurance, healthcare billing, physician office, health insurance processing or related experience</li><li>
Excellent problem-solving and decision-making skills required</li><li>
Attention to detail and committed follow through in communication with patients, providers and internal stakeholders</li><li>
Strong organizational skills</li><li>
Willing to work in a dynamic, fast paced environment and have the ability to multi-task and adapt to change while adhering to Program Standards</li><li>
Strong interpersonal skills, ability to work both independently and as part of a team,ability to jump in and help others as needed</li><li>
Empathetic listening skills in order to interact effectively with patients and providers</li><li>
Punctual, reliable with strong attendance record</li><li>
Proficient with Microsoft products</li></ul>
Physical Demands &amp; Work Environment<ul><li>
While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to sit for long periods of time, use hands to type, handle or feel; and reach with hands and arms. Prefer candidates who can type at least 35 words per minute with 97% accuracy.</li><li>
Although very minimal, flexibility to travel as needed is preferred.</li><li>
This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, etc.</li></ul> 
Why Work for Valeris?
We&rsquo;re committed to supporting the well-being and success of our team members. As part of our organization, full-time employees can expect:<ul><li>
Medical, dental, and vision plans, including HSA- and FSA-eligible options, with Valeris contributing toward premium costs</li><li>
Additional health support, including telehealth and Employee Assistance Program (EAP) services</li><li>
Company match on Health Savings Account contributions</li><li>
Free Basic Life and AD&amp;D coverage equal to your annual earnings, with a minimum of $50,000 and a maximum of $300,000</li><li>
Company-paid Short-Term Disability coverage, with the option to purchase Long-Term Disability</li><li>
401(k) Retirement Savings Plan with 100% match on the first 5% you contribute, with immediate vesting</li><li>
Paid Time Off (PTO) and Sick Leave to support work-life balance</li><li>
Team members receive nine paid holidays plus two floating holidays</li><li>
Opportunities for advancement in a company that supports personal and professional growth</li><li>
A challenging, stimulating work environment that encourages new ideas</li><li>
Work for a company that values diversity and makes deliberate efforts to create an inclusive workplace</li><li>
A mission-driven, inclusive culture where your work makes a meaningful impact</li></ul> 
Any offer of employment is contingent upon the successful completion of a background check and, depending on the position, a drug screen in accordance with company standards. Please note that this job description is not intended to be an exhaustive list of all duties, responsibilities, or activities associated with the position. Responsibilities and tasks may be modified at any time, with or without notice. 
Our Commitment to Equal Opportunity<div>
At Valeris, we don&rsquo;t just accept difference &ndash; we celebrate it, support it and we thrive on it for the benefit of our employees, our products and our community. Valeris is proud to be an equal opportunity employer.</div></div>

Reimbursement Specialist

TeamHealth

<div>
 
 External Job Description And Responsibilities
 
 
 
 
 TeamHealth
 
 is proud to be the leading physician practice in the U.S. providing exceptional patient care, together.
 
 TeamHealth has been recognized by Newsweek as one of America&rsquo;s Greatest Workplaces in Health Care for 2025
 
 &ndash;Becker&rsquo;s Hospital Review names TeamHealth among the top 150 places to work in healthcare. We continue to grow across the U.S. from our Clinicians to Corporate Employees. Join us!
 
 
 
 What We Offer
 
 
 
 <ul>
 <li>
 Career Growth Opportunities
 </li>
 <li>
 A Culture anchored in a strong sense of belonging
 </li>
 <li>
 Benefits (Medical/Dental/Vision) begin the first of the month following 30 days of employment
 </li>
 <li>
 401k (Discretionary match)
 </li>
 <li>
 Generous PTO
 </li>
 <li>
 8 Paid Holidays
 </li>
 <li>
 Equipment Provided for Remote Roles
 
 
 </li>
 </ul>
 
 Job Description Overview
 
 
 
 Position is responsible for reviewing rejections assigned to Denials Resolution in ETM System. Maintains accuracy and production to ensure denials are being processed efficiently.
 
 
 
 Essential Duties And Responsibilities
 
 
 
  Reviews ETM worklist to process rejections according to written procedures
 
 
  Reviews rejections to identify trends and carrier issues that need to be reported to management.
 
 
  Obtains appropriate carrier information for rejected claims.
 
 
  Information obtained from carrier indicates related to provider rejection. Directs rejections to the Provider Enrollment Department.
 
 
  Maintain knowledge of ETM system.
 
 
  Participates in monthly meeting with Denials Resolution Supervisor.
 
 
  Communicates with Denials Resolution Supervisor for unusual circumstances that may include adjustments, denials, fee schedules, claims, etc.
 
 
  Performs any and all duties as directed by Senior Representative, Denials Resolution Supervisor and Accounts Receivable Manager.
 
 
 
 Requirements
 
 
 
 
 QUALIFICATIONS / EXPERIENCE:
 
 
 
  High school diploma or equivalent.
 
 
  Minimum two years previous medical billing experience required with emphasis on
 
 
 research and claim denials in Accounts Receivable preferred.
 
 
  Demonstrated knowledge of physician billing.
 
 
  Demonstrated knowledge of health care reimbursement guidelines.
 
 
  Knowledge of ICD-10 and CPT-4 coding.
 
 
  Excellent oral and written communication.
 
 
  Knowledge of denials and review policies for all plans.
 
 
  Thorough working knowledge of physician billing policies and procedures.
 
 
  Computer literate.
 
 
  Excellent follow-up skills.
 
 
  Excellent organizational skills.
 
 
  Training classes and seminar attendance may require travel.
 
 
 
 Supervisory Responsibilities
 
 
 
  None
 
 
 
 Physical / Environmental Demands
 
 
 
  Job performed in a well-lighted, modern office setting
 
 
  Occasional standing/bending
 
 
  Occasional lifting/carrying (20lbs or less)
 
 
  Moderate stress
 
 
  Prolonged sitting
 
 
  Prolonged work on a PC/computer
 
 
  Prolonged telephone work
 
 
 This position may require manual dexterity and/or frequent use of the computer, telephone, 10-key,
 
 
 calculator, office machines (copier, scanner, fax) and/or the ability to perform repetitive motions
 
 
 and/or meet production standards to comply with the essential functions. Also, may require physical
 
 
 and/or mental stamina to work overtime, additional hours beyond a regular schedule and/or more
 
 
 than five days per week.
 
 
 
 Location
 
 
 
 Remote
 
 
 
 Job Category
 
 
 
 Admin-Clerical, Administrative, Healthcare
 
 
 
 LinkedIn
 
 
 
 No
 
 
 
 Career Builder
 
 
 
 Yes
 
 
 
 ID
 
 
 
 58708BR
</div>

Denials Representative

Mayo Clinic

<div><div>Why Mayo Clinic</div><div> 
Mayo Clinic is top-ranked in more specialties than any other care provider according to U.S. News &amp; World Report. As we work together to put the needs of the patient first, we are also dedicated to our employees, investing in competitive compensation and comprehensive benefit plans &ndash; to take care of you and your family, now and in the future. And with continuing education and advancement opportunities at every turn, you can build a long, successful career with Mayo Clinic.</div><div> 
</div><div>
Benefits Highlights 
<ul><li>
Medical: Multiple plan options.</li><li>
Dental: Delta Dental or reimbursement account for flexible coverage.</li><li>
Vision: Affordable plan with national network.</li><li>
Pre-Tax Savings: HSA and FSAs for eligible expenses.</li><li>
Retirement: Competitive retirement package to secure your future.</li></ul></div> 

Responsibilities 
The denials recovery representative is an experienced position within the Mayo Clinic enterprise denials management team. This position is responsible for investigating and resolving denied payments from third party payers in an effort to prevent lost reimbursement. The position will require experience in successfully appealing denials, including root cause analysis and coordination with payers to enable proper claim adjudication. The ability to effectively communicate with third party payer representatives and knowledge of appeal guidelines will be vital to the role. This position will be responsible for working denials of higher complexity, and will require knowledge of payer appeal requirements. This role will require adherence to quality assurance metrics, as well productivity standards that will enable denial key performance indicators to be met. 
Qualifications 
High School Diploma or GED and 2 years of experience in medical billing (hospital and/or professional) Required.
OR
Bachelor&rsquo;s Degree Required.
 Associates degree or higher preferred. Four years of relevant experience preferred.
Healthcare Financial Management Association (HFMA) Certification Preferred.
Ability to read and communicate effectively in English. Basic computer/keyboarding skills, intermediate mathematic competency. Good written and verbal communication skills. Knowledge of proper phone etiquette and phone handling skills. Must maintain regular and acceptable attendance; may be required to work weekend, holiday or OT hours. 
Knowledge of and experience with Epic, general knowledge of medical billing and collections processes, general knowledge of healthcare terminology and knowledge of contracted payers preferred.<ul><li>This position is a 100% remote work. Individual may live anywhere in the US.</li></ul>
**This vacancy is not eligible for sponsorship / we will not sponsor or transfer visas for this position.
During the selection process, you may participate in an OnDemand (pre-recorded) interview that you can complete at your convenience. During the OnDemand interview, a question will appear on your screen, and you will have time to consider each question before responding. You will have the opportunity to re-record your answer to each question - Mayo Clinic will only see the final recording. The complete interview will be reviewed by a Mayo Clinic staff member and you will be notified of next steps. 
Exemption Status 
 
Nonexempt 
 
Compensation Detail 
 
$21.91 -$34.27/ hour 
 
Benefits Eligible 
 
Yes 
 
Schedule 
 
Full Time 
 
Hours/Pay Period 
 
80 
 
Schedule Details 
 
Monday to Friday, 8:00 a.m. &ndash; 5:00 p.m. 
 
International Assignment 
 
No 
 
Site Description 
<div>
Just as our reputation has spread beyond our Minnesota roots, so have our locations. Today, our employees are located at our three major campuses in Phoenix/Scottsdale, Arizona, Jacksonville, Florida, Rochester, Minnesota, and at Mayo Clinic Health System campuses throughout Midwestern communities, and at our international locations. Each Mayo Clinic location is a special place where our employees thrive in both their work and personal lives. Learn more about what each unique Mayo Clinic campus has to offer, and where your best fit is.</div><div><div> 
Equal Opportunity</div><div> 
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, protected veteran status or disability status. Learn more about the &quot;EOE is the Law&quot;. Mayo Clinic participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. 
</div></div> 
 
Recruiter 
 
Ronnie Bartz</div>

Denials Recovery Rep-Remote

Syneos Health Commercial Solutions

<div>Description
The Field Reimbursement Specialist (FRS) will be responsible for the management of defined accounts in a specified geographic region in the ophthalmic therapeutic area, specifically supporting our client&rsquo;s products.
The FRS will execute the collaborative territory strategic plan through partnership with internal and external stakeholders, which may include call center services (HUB), sales, market access, and other collaboration partners. Responsibilities include ensuring understanding of reimbursement process, field reimbursement services, and patient support program. The Reimbursement Specialist will also work on patient-level reimbursement issue resolution, and thus will need access to be knowledge of and have had experience with patient health information (PHI).
Field Reimbursement Specialists manage daily activities that support appropriate patient reimbursement to our client&rsquo;s products in the provider offices and work as a liaison to other patient assistance and reimbursement support services offered by our clients. Activities include, but are not limited to:<ul><li>
Act as an extension of the product providing live one-on-one coverage support.</li><li>
Offer assistance from physician order to reimbursement, supporting the entire reimbursement journey through payer prior authorization to appeals/denials requirements procedures and forms.</li><li>
Reviewing patient-specific information in cases where the site has specifically requested the assistance in resolving any issues or coverage challenges.</li><li>
Reviewing patient insurance benefit options.</li><li>
Identifying alternate funding/financial assistance programs.</li><li>
Coordinating with our client&rsquo;s patient support services programs representatives.</li><li>
Educating physician office staff on the use of our client&rsquo;s patient assistance and call center support services, including web‑based provider programs.</li><li>
Provide information on relevant reimbursement topics related to our client&rsquo;s products.</li><li>
Serve as payer expert for defined geography and able to communicate changes to key stakeholders in a timely manner.</li><li>
Provide office support in accurate coding and billing for the client&rsquo;s products.</li></ul>
Minimum Qualifications &amp; Education:<ul><li>
Bachelor&rsquo;s degree required</li><li>
Minimum two years&rsquo; of access and reimbursement, managed care, and/or billing and coding support experience</li><li>
Experience working with Buy and Bill products and a thorough understanding of the entire reimbursement process from script to injection required</li><li>
Ophthalmic, retina specialists and biosimilar experience preferred</li><li>
Experience establishing relationships within a practice by working closely to help remove reimbursement barriers to specialty products for their patients</li><li>
Knowledge of Centers of Medicare &amp; Medicaid Services (CMS) policies and processes with expertise in Medicare Part D (Pharmacy Benefit design and coverage policy) a plus</li><li>
Knowledge of Managed Care, Government, and Federal payer sectors, as well as Integrated Delivery Network/Integrated Health Systems a plus</li><li>
Ability to travel and cover large multistate geography territories, 50% travel required</li><li>
Excellent presentation and project management skills</li></ul>
The annual base salary for this position ranges from $155,000 to $160,000. The base salary range represents the anticipated low and high of the Syneos Health range for this position. Actual salary will vary based on various factors such as the candidate's qualifications, skills, competencies, and proficiency for the role. In addition, some positions may include eligibility to earn commissions/bonus based on company and / or individual performance.
At Syneos Health, we are dedicated to building a diverse, inclusive and authentic workplace. If your past experience doesn&rsquo;t align perfectly, we encourage you to apply anyway. At times, we will consider transferable skills from previous roles. We also encourage you to join our Talent Network to stay connected to additional career opportunities.
Why Syneos Health? Our ability to collaborate and problem-solve makes a difference in patients&rsquo; lives daily. By joining one of our field access teams, you will partner with industry experts and be empowered to succeed with the support, resources, and autonomy needed to successfully navigate the complex reimbursement landscape. The diversification and breadth of our new and existing partnerships create a multitude of career paths and employment opportunities. Join our game-changing, global company dedicated to creating better, smarter, faster ways to get biopharmaceutical therapies to patients Experience the thrill of knowing that your everyday efforts are contributing to improving patients&rsquo; lives around the world.
Work Here Matters Everywhere | How are you inspired to change lives?
Syneos Health companies are affirmative action/equal opportunity employers (Minorities/Females/Veterans/Disabled)
Syneos Health has a voluntary COVID-19 vaccination policy. We strongly encourage all employees to be fully vaccinated. Additionally, certain local governments or Syneos Health customers may have vaccine requirements that apply to some of our employees. These employees are required to submit proof of vaccination to Syneos Health and maintain compliance with these requirements.
 
At Syneos Health, we believe in providing an environment and culture in which Our People can thrive, develop and advance. We reward and recognize our people by providing valuable benefits and a quality-of-life balance. The benefits for this position will include a competitive compensation package, Health benefits to include Medical, Dental and Vision, Company match 401k, flexible paid time off (PTO) and sick time. Because certain states and municipalities have regulated paid sick time requirements, eligibility for paid sick time may vary depending on where you work. Syneos Health complies with all applicable federal, state, and municipal paid sick time requirements. 
400003488</div>

Field Reimbursement Specialist

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