• Reimbursement Specialist

    J&J Family of Companies (Pittsburgh, PA)


    At Johnson & Johnson, we believe health is everything. Our strength in healthcare innovation empowers us to build a world where complex diseases are prevented, treated, and cured, where treatments are smarter and less invasive, and solutions are personal. Through our expertise in Innovative Medicine and MedTech, we are uniquely positioned to innovate across the full spectrum of healthcare solutions today to deliver the breakthroughs of tomorrow, and profoundly impact health for humanity. Learn more at https://www.jnj.com

    Job Function:

    Customer Management

    Job Sub** **Function:

    Customer Service Operations

    Job Category:

    Business Enablement/Support

    All Job Posting Locations:

    Orlando, Florida, United States of America, Phoenix, Arizona, United States, Pittsburgh, Pennsylvania, United States of America, Raleigh, North Carolina, United States

    Job Description:

    Our expertise in Innovative Medicine is informed and inspired by patients, whose insights fuel our science-based advancements. Visionaries like you work on teams that save lives by developing the medicines of tomorrow.

     

    Join us in developing treatments, finding cures, and pioneering the path from lab to life while championing patients every step of the way.

     

    Learn more at https://www.jnj.com/innovative-medicine

     

    We are searching for the best talent for a Reimbursement Specialist to be in Pittsburgh, PA, Raleigh, NC, Phoenix, AZ, or Orlando, FL.

    Purpose:

    The Reimbursement Specialist (RS) is a professional role that handles payer inquiries, manages benefit investigations to determine patient eligibility and coverage, and addresses coverage challenges. This role serves as the main contact for payers and collaborates cross-functionally to support the patient service program.

    Responsibilities:

    + Assess and analyzepatient benefits in coordination with internal program operations, insurance providers, and specialty pharmacy liaisons.

    + Work independently to complete assigned workin accordance withStandard Operating Procedures and defined service levels toreviewbenefitverification process,resolve coverage challenges,and answer inquiries.

    + Use high-level problem-solving skills to research cases and resolve independently using creativity, innovation,and professional judgement to make sound decisions.

    + Maintain frequent phone contact with payers to gather all necessary information related to case/patient information, insurance coverage,prior authorization (PA)andappeals processing.

    + Efficiently processpatient and prescriber requeststoaccelerateaccess to therapy.

    + Serve as expert on payer trends, product access, and reporting reimbursementinsightsand/or delays,i.e.,denialsordelays.

    + Frequentlycommunicatewith program managementonnew insurancerequirements and trends.

    + Collaborate with internal& externalstakeholdersbyprovidingreimbursement informationas needed

    + Maintainaccurate, compliant documentation and communication to support program goals.

    + Uphold patient privacy laws and foster collaborative team relationships.

    + Other duties as assigned.

    Required Qualifications:

    + High school diplomaor equivalent.

    + Minimum of 2years of experience incasemanagement or insurancerolespreferably within apharmacy,HUB,orhealthcare setting.

    + Experience using an outbound calling platform to make external calls

    + Ability to independently manage case load, prioritize work, and usetime management skills to meetservice level agreements

    + Ability to efficiently navigate multiple screens and systems to perform work.

    + Ability to work assigned 8hrshift between program operating hours of 8am-8pm EST.

    + Proven ability to manage a case load, prioritize tasks, and build relationships.

    + Apply company policies and procedures to resolve challenges

    + Ability to proficiently use Microsoft programs.

    + Ability to thrive in a regulated, remote, high-volume environment

    Preferred Qualifications:

    + UndergraduateDegree

    + Understanding of plan types – Government, Commercial, Medicaid, VA, Fed

    + Knowledge of insurance structure (ex PBM’s, major medical plans, co-pay assistance /cards)

    + Working Knowledge of Third-Party and other Foundation programs

    + Basic understanding of Co-Pay Assistance

    + Understanding ofHUB patientjourney,workflow, andtriageis a plus.

    + Possess a strong understanding of biologic/specialty pharma market and patient access challenges

     

    \#Li-Remote

     

    Johnson & Johnson is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, age, national origin, disability, protected veteran status or other characteristics protected by federal, state or local law. We actively seek qualified candidates who are protected veterans and individuals with disabilities as defined under VEVRAA and Section 503 of the Rehabilitation Act.

     

    Johnson & Johnson is committed to providing an interview process that is inclusive of our applicants’ needs. If you are an individual with a disability and would like to request an accommodation, external applicants please contact us via https://www.jnj.com/contact-us/careers , internal employees contact AskGS to be directed to your accommodation resource.

    Required Skills:

    Preferred Skills:

    Accountability, Communication, Customer Analytics, Customer Centricity, Customer Service Philosophy, Customer Support Operations, Customer Support Platforms, Customer Support Policies and Procedures, Customer Support Trends, Detail-Oriented, Inquiry Handling, Issue Escalation, Order Processing, Process Oriented, Service Excellence, Service Request Management