Candidates must live within a drivable distance of our Ft. Worth, TX or Cary, NC locations.
Typically requires 3+ years of subject matter experience including exhibiting leadership capabilities.
3+ years of specialty pharmacy, medical benefit reimbursement, provider billing, revenue cycle, or hospital reimbursement experience.
People leadership or supervisory experience.
Demonstrated medical benefit and billing experience required.
Experience in the specialty healthcare or pharmaceutical segment with understanding of healthcare continuum and relationship between manufacturers, patients, providers, and payers
Strong understanding of health insurance coverage and reimbursement processes, including knowledge of medical coding and billing practices.
Knowledge of payer policy interpretation, coding, claims adjudication, and reimbursement methodologies.
Knowledge of applicable healthcare laws and regulations, including HIPAA, Medicare, and Medicaid guidelines.
Proficiency in Microsoft Office Suite, including Word, Excel, and PowerPoint
Knowledge of LOAs, SCAs, payer/provider contracting implications, and treatment site reimbursement.
Experience supporting A/R, denial prevention, and reimbursement optimization.
20% travel required