BrightOwl Loader Loading

Specialist, Reimbursement and Appeals Santa Monica United States,  

Job Score (company)


Posted on : 26 February 2017

Project Description

Description:
  • Our company is a clinical-stage biopharmaceutical company focused on the development and commercialization of novel cancer immunotherapy products designed to harness the power of a patient s own immune system to selectively target and kill cancer cells.  
  • Our core technology involves the genetic engineering of T cells, or white blood cells, to express either chimeric antigen receptors (CARs) or T cell receptors (TCRs) for the treatment of advanced solid and hematological malignancies.  
  • We are on a rapid growth trajectory and have a highly energized and accomplished team. 
  • Our company is publicly traded with a current market capitalization well over $2 Billion.
  • The Reimbursement and Appeals Specialist is responsible for managing all reimbursement activities for oncology patients from benefit investigations, prior authorizations, pre-determinations, to appeals. 
  • The Reimbursement/Appeals Specialist will be responsible for assisting with gaining coverage for a novel new product in the Oncology space.



Responsibilities (include but are not limited to):
  • Verifies patient eligibility and conducts complete benefit investigations 
  • Determines best approach when completing prior authorizations / pre-determinations 
  • Confirms coverage and identifies any barriers to coverage for a new product 
  • Educates the payers regarding the new product and monitors adoption and acceptance of product 
  • Identifies and resolves claims / eligibility issues 
  • Ensures that all claims submitted to government and private payers comply with applicable federal and state regulations 
  • Provides timely follow-up on unpaid, denied, and / or short paid claims 
  • Understands and interprets payer guidelines and policies 
  • Creates letters of medical necessity 
  • Drafts, submits, and tracks action on appeal letters, reconsideration and re-determination requests, and other communication within medical payers on behalf of providers and patients 
  • Interprets clinical information, performs searches for relevant articles and assists the customer through education and clear communication 
  • Tracks the status of outstanding appeals and trending appeals successes to help develop appeal strategies for specific payers 
  • Manages an appeal spreadsheet and notifies the program team and managed care department of payer issues related to appeals 
  • Ensures all timelines and customer commitments are met 
  • Minimizes obstacles to coverage by using judgment to successfully plan next steps 
  • Makes constant case assessments and makes informed, methodical decisions throughout a very complex process 
  • Assists customers to navigate healthcare insurance reimbursement issues through education, information, and exceptional communication 
  • Supports the Operations Program Manager on program initiatives and departmental goals 
  • Enters insurance and benefit data into the program system 
  • Responds to internal team member case-related questions 
  • Participates in daily informal check-in s with team 
  • Attends weekly team meeting 
  • Responds to emails from internal and external customers that need to be addressed immediately by a reimbursement / appeals specialist 


Requirements:
Key attributes:
  • Excellent oral and written communication, and customer service skills 
  • Strong writing skills and excellent organizational ability 
  • Clinical knowledge is preferable but not essential 
  • Proven ability to think strategically and to prioritize 
  • Exceptional problem solving skills 
  • Exceptional computer skills with proficiency in MS Office Suite, specifically MS Word and Excel 
  • Ability to work enthusiastically with others 
  • Self-confident and resourceful 
  • Exhibits initiative, flexibility, and dependability 
  • Quality work and attention to detail 
  • Humility and integrity 
  • Team Player 
  • Customer-focused 
  • Business acumen / business savvy 


Work experience:
  • Three or more years of reimbursement experience preferably in a pharma / biotech or health services environment specializing in oncology 
  • Proficiency in healthcare insurance reimbursement including benefit investigation and design, prior authorizations and pre-determinations 
  • Full understanding of the insurance approval / denial / appeals process; previous direct experience in submitting appeals and advocating for appropriate clinical treatment of patients is highly desired 
  • Experience navigating through the public and private payers and working through managed care systems 


Education:
  • Undergraduate degree preferred 


About Us:
  • Our company is an equal opportunity employer. 
  • We are able to offer the opportunity to be part of the first 200 employees in this successful, fast growing company.  
  • A place everyone knows your name and respects your opinion while at the same time offering benefits and time off packages commensurate to any large corporation. 

Locations

Santa Monica CA

Find a Job Find Candidates

Similar Jobs

More jobs from Kite Pharma

Other jobs in United States

Other jobs in Santa Monica

Other similar job in Santa Monica

Other Jobs

Most Recent Searches

Most Famous Searches

You might also like