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Express Scripts Billing & Reimbursement Specialist III - Accredo in Orlando, Florida

POSITION SUMMARY

Using knowledge on CMS regulations and Accredo’s line of Specialty Pharmacy business, this position serves as the first-line receiver/monitor/screener of new or revised governmental regulations that can potentially affect Accredo’s Billing and Collections business. The regulatory communications can come from a variety of sources and include, but not limited to, National or Local Coverage Determination (NCD or LCD), MLN, revised or new regulations, etc. This position also receives, logs, and initially processes requests for assistance with clinical appeals on Core/Oncology and selected Advanced Therapy medications.

ESSENTIAL FUNCTIONS

  • Screens incoming communications for relevancy and importance, then channels them to the next levels within the regulatory team for processing
  • Monitors the regulatory team’s communication portals (regular mail, JP Morganbox, email, and faxes) for incoming communications
  • Receives and initially processes requests for assistance with clinical appeals for Core/Oncology a few advanced therapy medications (coagulation factors), then channels them to the next level within the team for further processing
  • Responds to internal requests for clarification/guidance on established guidance and communication, using resources from the Medicare SharePoint site, Drug Database, and others.Acts as a back-up data-entry person for the team for information that needs to be logged and entered into the spreadsheets.
  • Sends appeals packages out via web-portal (uploading onto Connex, etc.), Certified mails, regular mail, FedEx or faxes spreadsheet.
  • Performs other tasks as assigned by leadership

QUALIFICATIONS

  • High School Diploma or GED required
  • 3 – 5 years of relevant experience working with Medicare/Medicaid on billing/collection/appeals.
  • Basic PC skills, including Microsoft Excel, Word, Outlook, PowerPointand the ability to search the internet effectively.
  • Detailed oriented, good organizational skills, good verbal and written communication skills, good email etiquette.

ABOUT THE DEPARTMENT

Through our range of health care products and services offered, Accredo team members provide in-depth care for patients with chronic health conditions like hemophilia, oncology, rheumatoid arthritis and growth hormone deficiency. In addition to health care products, we provide comprehensive management services – including outcomes measurement, counseling, clinical care management programs, social services and reimbursement services. By performing in these very high-touch roles, employees have a daily opportunity to make a positive impact on their patients’ lives.

ABOUT EXPRESS SCRIPTS

At Express Scripts, we dare to imagine a better health care system, and we’re driven to make it happen. Where some see obstacles, we see possibilities. We’re challengers, difference-makers and opportunity-seekers, united with our partners in pursuit of a simpler, more sustainable system and better health for all.

We have always acted first to take on the toughest challenges. We uniquely partner across the health care ecosystem to uncover opportunities, take action, advance health care and deliver better outcomes – like no one else can. We believe health care can do more. We are Champions For BetterSM.

Express Scripts, part of Cigna Corporation, unlocks new value in pharmacy, medical and beyond to further total health for all.

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