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Case Reimbursement Specialist

Your role:
The Case Reimbursement Specialist plays an integral role within EMD Serono's Patient Support Services Call Center, MS LifeLines (MSLL) as part of the overall Marketing function within the Neurology & Immunology Therapeutic area. This individual will be directly responsible for providing reimbursement assistance and support for patients, family members, caregivers, nurses, physicians, pharmacists and internal colleagues. All cases will be handled with personalized attention and the utmost confidentiality. In this role the individual will address reimbursement related inquiries, assess patients' coverage options, provide eligibility and benefit verification, secure insurance authorizations, advocate for maximum reimbursement coverage and provide patient assistance for those in need of financial support.
Consistently provide a high level of customer service to both internal (sales force, managed care, nurses) and external customers (patients, physicians, pharmacies, insurers).
Maintain accountability for day-to-day patient reimbursement activities, workload and overall workflow.
Manage tasks and activities assigned by specific geographic territories to ensure a high level of patient and physician satisfaction
Provide feedback to patient or provider on services offered and share unique situations/issues to ensure common response from patient support services.
Provide feedback to patients or provider relative to insurance coverage with certain carriers and/or plans.
Work on patient's behalf to identify and assess reimbursement coverage options for those with insurance and to coordinate and/or investigate financial options for those without insurance.
Work with physician offices and/or pharmacies to facilitate the process of obtaining prior authorization from third party payers in order to maximize patients' access to treatment.
Monitor, follow-up with and record all insurance re-authorizations required by payers to help ensure compliance and continuity of treatment.
Help support the appeal process, with consent from the patient, caregiver and/or the provider
Deliver presentations regarding reimbursement options to provider's offices, specialty pharmacies and patient programs where appropriate.
Align with Managed Care Regional Account Managers (RAM) and National Account Managers (NAM) at the regional level to maintain a knowledge regarding Payors, Pharmacies and maintain a working knowledge regarding formulary opportunities or challenges.
Ensure a continued effort to reduce the number of non-compliant patients starts
Maintain database for recording, managing, and monitoring patient activities for those requiring reimbursement support.
Analyze data for reporting and trending and report to departmental manager
Maintain a collaborative approach with members of call center team in order to offer the best possible outcome for all customers.
Demonstrate the utmost sensitivity and confidentiality to information while maintaining a high level of professionalism.
Assume additional projects on an as needed basis.
Continued education and training is required in order to maintain technical expertise in the assigned therapeutic area and to keep current on approved product information and promotional items.
Attendance of certain association meetings during the year may be required to receive updated information or competitive review.
Who you are:
A minimum of two years reimbursement and customer care experience in a medical field and/or pharmacy technician experience is favorable. Preferably with patient interaction or educational support
College Degree required (Associates/ Bachelors) or equivalent. Pharmacy Technician is a plus
Bilingual capability is a plus.
Normal office duties.
Must be flexible in working hours, shift work
Overtime may be required.
Limited travel will be required
Physical Requirements (PPE, lifting)
Job Requisition ID: 183078
Location: Rockland
Career Level: C - Professional (1-3 years)
Working time model: full-time

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