Medical Reimbursement Specialist - 10:00am-7:00pm Shift
EMD Serono (Boston South, Massachusetts)

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Organisation Description
EMD Serono, Inc. is a leader in US biotechnology, focusing on reproductive health, metabolic endocrinology, and neurology. More than 500 people work in the world-class facilities in Rockland, MA, and approximately 250 work in the field.

Description

PURPOSE OF THE ROLE:The Medical Reimbursement Specialist (MRS) will play an integral role within Serono&'s Patient Support Call Center (i.e. MS LifeLines) as part of the overall Patient Marketing function. This individual will be directly responsible for providing reimbursement assistance and support to patients as well as family members, caregivers, nurses, physicians, and pharmacists. All cases will be handled with personalized attention and confidentiality. In this role, this individual will address reimbursement related inquiries, assess patients&' coverage options, provide eligibility and benefit verification, secure insurance authorizations, advocate for maximum reimbursement coverage on a case-by-case basis from third party payers, and provide support on insurance appeals. PRIMARY RESPONSIBILITIESConsistently 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 advocacy cases, follow up tasks and overall workflow. Work on patient&'s behalf to identify and assess reimbursement coverage option 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 to overturn insurance denials and/or benefit exclusions, when needed. Maintain database for recording, managing, and monitoring patient cases requiring reimbursement support. Provide and analyze data for reporting and trending. Serve as liaison and resource for addressing general, medical, and product and/or device related questions. Maintain a collaborative approach with members of call center team. Demonstrate sensitivity and professionalism; maintain a high level of patient confidentiality. Assume additional projects on an as needed basis. Perform the duties and responsibilities of Customer Support Specialist as necessary.MAIN INTERFACES:INTERNALLY: Database:Ensure privacy of patient information that is provided. Ensure accurate and timely database input &- ensure update of therapy start dates and dose.CustomersAccount Specialists and Sales Representatives Colleagues and business partnersEXTERNALLY:Insurance Companies Patients, Healthcare ProfessionalsKEY ROLE FACTORS:ACCOUNTABILITY AREA:Each MRS maintains responsibility for specific geographic territories. It is critical that each MRS aggressively manages his/her territory to ensure patient and physician satisfaction. AUTONOMY && AUTHORITY:The MRS participates in molding and modifying policies and procedures for improving the reimbursement process from the patient&'s perspective. It is vitally important for each MRS to consider new and creative ways to reduce the amount of time necessary to start a new patient on therapy. The MRS also assists the patient in selecting a pharmacy that provides the utmost of convenience and value.

NATURE && AREA OF IMPACT:

Provide feedback from customers on services offered and share unique situations/issues to ensure common response from patient support services.

Provide feedback relative to specific difficulties with certain carriers and plans in order to identify Managed Care opportunities.

** 10:00am-7:00pm Shift**



EDUCATION LEVEL AND LANGUAGES REQUIRED:High School Diploma or equivalency required, College Degree preferred (Associates/ Bachelors) Fully Bilingual capability (Spanish) a plus. Continued education is required. Technical expertise in assigned therapeutic area is necessary and updates in current therapy will be required. For example in MS &- keep up-to-date of new therapies, Internet feedback/comments, and industry advancements. Attendance of certain association meetings during the year may be required to receive updated information or competitive review. PROFESSIONAL SKILLS, QUALIFICATONS AND EXPERIENCE (years experience minimally necessary for success in role)Two years reimbursement and customer care experience in a medical field, preferably with patient interaction or educational support. COMPETENCIES (knowledge, skills, abilities, traits)Exceptional customer service and telephone skills. Strong computer skills (customer contact databases, Windows, Word, Excel) preferred. Data Entry/Typing skills necessary. Ability to manage multiple and/or repetitive tasks. ADA REQUIREMENTS (i.e., normal office duties; must be able to push, lift, pull up to 30 pounds; etc.)Normal office duties. Must be flexible in working hours, shift work and weekend shifts may be required. Limited travel will be required.