This is a local hire only designated position, as relocation assistance is not available for the position.
The Access Solutions Reimbursement Specialist investigates insurance benefits and obtains prior authorization information of Genentech products at the patient/family request.
The Reimbursement Specialist is an Individual Contributor who reports to an Access Solutions Supervisor.
Investigate patient s insurance benefits.
Identify network providers, provider restrictions, and co-pays as needed.
Document requirements for prior authorization and medical review process.
Document activities appropriately in progress notes.
Pursue product coverage for patients in accordance with the authorization requirements within the departments established performance criteria.
Maintain payer profiles by recording payer specific data promptly into the system.
Convey outcomes of benefit investigation to internal contacts (i.e. case managers).
Learn processes for multiple products and effectively apply learnings to provide effective reimbursement services.
Conduct all work in a compliant manner.
Consult with team members on an as needed basis.
Periodic mandatory overtime throughout the year is required in Access Solutions Operations. This may include, but is not limited to, high referral season (Blizzard, Enrollment renewal), new product or system launches, new line extensions, or any unexpected surge in volume or backlog situations. May include weekends as needed.
Recommended Skills and Experiences:
Bachelor's degree is preferred or equivalent experience.
A minimum of 3 years reimbursement experience is preferred.
Knowledge of managed care industry including government payers.
Proficient in all aspects of reimbursement (i.e., benefit investigations, payer
reimbursement policies, regulatory and administrative rules).
Understands reimbursement/funding resources and how to access these resources.
Excellent investigational and analytical skills with a proven ability to communicate effectively in both written and verbal format.
Ability to work collaboratively in a team structure and responsibly delegate next steps to appropriate team members.
Demonstrates effective problem solving and excellent customer service.
Exceptional attention to detail and ability to prioritize tasks.
Must be able to follow written Standard Operating Procedures.
Inspiring and Influencing
Teamwork and Collaboration
Genentech, a member of the Roche group and founder of the biotechnology industry, is dedicated to pursuing groundbreaking science to discover and develop medicines for people with serious and life-threatening diseases. To solve the world's most complex health challenges, we ask bigger questions that challenge our industry and the boundaries of science to transform society. Our transformational discoveries include the first targeted antibody for cancer and the first medicine for primary progressive multiple sclerosis.
Diversity and Inclusion (D&I) are critical to the success of our company and our impact on society. We believe that by championing diversity of background, thought and experience, we can foster a sense of belonging and provide an environment where every employee feels valued, included, and able to contribute their best for the patients we serve. We’re focused on attracting, retaining, developing and advancing our people to their full potential by rewarding bold ways of thinking and integrating inclusive behaviors into every aspect of our work.
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