Reimbursement Specialist

A proud member of the Elevance Health family of companies, Paragon Healthcare brings over 20 years in providing life-saving and life-giving infusible and injectable drug therapies through our specialty pharmacies, our infusion centers, and the home setting.

Location: 3033 W George Bush Highway, Suite 100, Plano, Texas 75075.

This position will take part in Elevance Health's hybrid workforce strategy which includes virtual work and 1-2 days in office per week.

The Reimbursement Specialist is responsible for the administration of prior authorizations requests for patients whose health plan requires drug prior authorizations for different therapy types.

How You Will Make an Impact

Primary duties may include, but are not limited to:

• Reviews accuracy and completeness of prior authorization information requested and ensures supporting documents are present and meet company set standards.

• Assists with the completion of medical necessity documentation to expedite approvals and ensures that appropriate follow up is performed.

• Collaborates with other departments to assist in obtaining prior authorizations/appeals.

• Document insurance company interactions and all prior authorization information in system.

• Reviews insurance denials and submit appeals as permitted by payor.

• Contacts physician offices as needed to obtain demographic information or medical data.

Minimum Requirements:

• Requires a HS diploma or GED and a minimum of 2 years of experience processing pharmacy prior authorizations, and a minimum of 1 year of experience applying knowledge of Medicare, Medicaid and Managed Care reimbursement guidelines; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities, & Experiences:

• Specialty pharmacy or healthcare experience highly preferred.

• Medical terminology training or exposure preferred.

• Proficient in Microsoft Excel, with experience in pivot table functionalities.

• Basic understanding of credits, debits, and prompt pay discounts.

• Accounts Payable Processing with 3-way match, with inventory experience strongly desired.

• Experience and ability to work in high-volume healthcare environments preferred.