Navitus Health Solutions

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Reimbursement Specialist I, Specialty

at Navitus Health Solutions

Posted: 6/6/2019
Job Reference #: 5000498781806

Job Description

Requisition Number



Lumicera Madison: Madison, Wisconsin

Other Locations



  • High school diploma or GED. Required. Bachelor's degree preferred.
  • Wisconsin Employees-Certified CPhT certification through PTCB, preferred.
  • Arizona Employees - Must be a licensed pharmacy technician trainee in the state of AZ. Must attain CPhT certification, through PTCB, within 12 months of hire.
  • Minimum two years pharmacy support experience or healthcare environment experience preferred.
  • Experience with pharmacy insurance claims billing, benefit assessment, billing/claims documentation, claims auditing, or insurance verification preferred.

Job Description

Under direction from the Supervisor, Specialty Pharmacy Services and pharmacists in the Specialty Pharmacy, the Reimbursement Specialist Iis primarily responsible for following standard operating procedures to monitor, review and investigate claim submissions and responses. The Reimbursement Specialist I shall have knowledge of billing procedures and work to reduce discrepancies, inaccuracy and outstanding balances. The Reimbursement Specialist I may also assist in the maintenance of the patient record, translation of prescription and patient information into the pharmacy dispensing software and assisting in triage of prior authorizations. This position may function with and assist any other area in the facility as needed with regard to pharmacy technician type duties as needed.

Essential Functions:

  • 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.
  • Participate, as necessary, in conferences and meetings related to reimbursement/billing.
  • Responds to employee/patient/client questions or complaints regarding reimbursement and/or billing.
  • Works with internal teams to review and resolve claim issues.
  • Maintains accurate reference information relating to reimbursement and copay assistance.
  • Responsible for accurate and thorough documentation of information, insurance and prescriptions/orders within the patient profile.
  • Responsible for other duties as assigned by the pharmacist lead/upper management.
  • May be asked to perform other duties as requested by Supervisor.
  • The Employee will act in accordance with all applicable federal and state laws and with the highest ethical standards that we consistently strive to achieve. Thus, legal and ethical compliance is an essential duty of each employee.