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Role Description

Lumicera Health Services is seeking a Reimbursement Specialist Team Lead to join our team! Under direction from the Supervisor or Assoc. Manager, Specialty Pharmacy Services and pharmacists in the Specialty Pharmacy, the Reimbursement Specialist Team Lead is primarily responsible for following standard operating procedures to monitor, review and investigate claim submissions and responses. Additionally, the Reimbursement Team Lead will provide guidance and corrective action to applicable pharmacy staff. The Reimbursement Specialist Team Lead shall have knowledge of billing procedures and work to reduce discrepancies, inaccuracy, and outstanding balances. This individual may be assigned to additional projects and responsibilities outside of regular pharmacy duties and will help to mentor and train new and existing Lumicera employees. This position may function with and assist any other area in the facility as needed.

Responsibilities

• Responsible for ongoing monitoring of claims activity for accuracy and successful submission
• Responsible for ensuring that patient billing information is set up appropriately in the pharmacy software
• Responsible for understanding the nuances of copay programs, copay cards, and how that relates to Lumicera patient copay structures
• Responds to employee/patient/client questions or complaints regarding reimbursement and/or billing
• Works with internal teams to review and resolve claim issues
• Responsible for managing failed claims in a timely fashion
• Maintains accurate reference information relating to reimbursement and copay assistance
• Assists in mentoring and training new and existing Lumicera employees to maintain the Lumicera service model
• Other duties as assigned

Qualifications

• High school diploma or GED. Some college preferred
• CPhT Preferred
• Pharmacy technician license or pharmacy technician trainee license is strongly preferred in states requiring pharmacy technician licensure
• Experience with pharmacy, health plan or clinical insurance claims billing, benefit assessments, billing/claims documentation, or claims auditing is preferred
• Preferred understanding of Specialty Pharmacy drugs including REMS and Limited Distribution Products best practices
• At least 2 years’ experience and demonstration of proficiency in position at Lumicera or equivalent preferred
• Must have schedule flexibility and be able to work overtime to support company needs
• Participate in, adhere to, and support compliance program objectives
• The ability to consistently interact cooperatively and respectfully with other employees

Benefits

• Top of the industry benefits for Health, Dental, and Vision insurance
• 20 days paid time off
• 4 weeks paid parental leave
• 9 paid holidays
• 401K company match of up to 5% - No vesting requirement
• Adoption Assistance Program
• Flexible Spending Account
• Educational Assistance Plan and Professional Membership assistance
• Referral Bonus Program – up to $750!