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Reimbursement Specialist

United States - California - Santa MonicaCommercial/Sales OperationsRegular

Job Description

The Reimbursement Specialist focuses on resolving complex coverage and reimbursement issues that may create patient barriers to access for cell therapy. The individual in this role uses their knowledge of coverage, patient assistance programs and Kite resources to investigate and verify benefits and reduce patient access barriers. This role reports to the Senior Manager, Patient Program Operations and is based in Santa Monica, CA.

Key Responsibilities

  • Conduct benefits investigations and verifications for new cell therapy patients
  • Convey outcomes of benefit investigation to internal and external contacts (i.e. case managers and financial coordinators)
  • Coordinate with payers during the prior authorization process, including direct follow-up during appeals process if coverage is denied
  • Qualify patients for travel and lodging benefits in response to customer requests and manage referrals to external vendor for patients who are qualified
  • Respond to patient and customer questions about benefits as needed
  • Partner with Market Access and Payer Account team in support and development of customer facing materials
  • Ensure compliance with patient and customer services/support provided
  • Provide back-fill support for Intake Coordinators as needed (i.e., receive incoming data [such as travel / lodging applications, insurance cards, purchase order, trade policy cover] via fax or other sources and review, triage and route data to the appropriate department or team member as applicable)

Basic Qualifications

Bachelor’s degree

OR

Associates degree and 2 years of reimbursement experience

OR

High School Diploma and 3 years of reimbursement experience

Preferred Qualifications

  • Excellent investigational and analytical skills with the ability to inventively and effectively solve problems
  • Ability to work independently and in a team environment
  • Excellent investigational and analytical skills with the ability to inventively and effectively solve complex reimbursement problems
  • A proven ability to communicate effectively in both written and verbal formats
  • Ability to provide excellent customer service with high customer empathy
  • Proficient in all aspects of reimbursement (i.e., benefit investigations, payer reimbursement policies, regulatory and administrative rules) as well as claims and appeals process
  • Hospital billing and coding experience
  • Knowledge of managed care industry including government payers