Reimbursement Specialist

Job overview

The Reimbursement Specialist role is onsite in Maitland, FL. Compensation is not specified. The specialist supports medical doctors’ offices by researching drug- or treatment-specific coverage and benefits and reports to the Program Manager.

What you'll do

• Investigate benefit requests submitted by medical offices using test claims, electronic benefit verification, or phone
• contact insurers about specialty pharmacy and prescription benefits
• update pharmacy claim processing information in patient records
• document benefit results
• identify and correct system errors
• escalate priority issues
• route coverage results to the Case Manager
• follow up on prior authorization status as required
• document calls
• and review referrals and cases for accuracy and completeness while maintaining HIPAA confidentiality.

What we're looking for

Skills & competencies

reimbursement specialist

maitland fl

elusa health

pharmacy benefits

insurance verification

benefit investigation

specialty pharmacy

prescription benefits

prior authorization

patient records

hipaa

case management

data entry

healthcare

Work arrangement

• Weekend coverage required

Why this role

Requires a high school diploma or GED and 1–2 years of experience in a pharmacy or insurance verification environment, including pharmacy benefit investigation, retail pharmacy, or specialty pharmacy adjudication. An associate degree or equivalent healthcare or pharmacy education is preferred.

About the employer

Elusa Health is hiring for this role. Industry: All Other Miscellaneous Ambulatory Health Care Services. Sector: 62.