Xerox Sr. Reimbursement Specialist, Case Manager in Somerset, New Jersey

Job Summary:

The TMS Health Patient Access Solutions group is nationally recognized for its planning, content, and process expertise in the design and management of compliant, streamlined reimbursement and patient assistance programs. The TMS Health Patient Access Solutions group is dedicated to delivering the highest-quality, leading-edge services so patients can experience the best possible medical outcomes.

The Sr. Reimbursement/Patient Support Specialist strives to eliminate barriers to reimbursement and access in patients with complex and rare medical conditions. The Sr. Reimbursement Specialist, reporting to the Program Manager or Program Supervisor, navigates patient’s healthcare insurance, performs administrative functions and interacts with key stakeholders in a call-center environment.

Reimbursement specialists require personal integrity, strong empathy, a high level of accuracy and superb attention to detail.

Key Job Responsibilities:

(Duties may include, but not limited to all or some of the following)

· Conducts medical and pharmacy benefit insurance verifications and investigations for commercial and government payors

· Builds relationships with patients, caregivers, HCSs, and Sales Team to collect / share information and coordinate participation in the program

· Communicates with insurance companies, and third-party vendors to collect / share information and coordinate participation in the program

· Researches available disease-specific information in the assigned region: events, activities, resources, support groups, etc.

· Handles complex calls in a call-center environment

· Communicates with internal and external departments to facilitate coordination of information / resources

· Reports Adverse Events (AE) and Product Quality Complaints (PQC), as required and as per policy

· Strictly adheres to Standard Operating Procedures (SOPs)

· Accurately interprets patient insurance, prescription and other health-related documentation, as needed

· Validates and enters prescription orders, as appropriate

· Completes casework in a timely manner with consistent follow-up as the accountable case manager

· Maintains patient confidentiality

· Advocates on behalf of the patient to problem-solve any issues or obtain necessary information

· Understands prescription drug benefit management techniques including Formularies, Prior Authorizations, etc.

· Performs clerical and administrative functions such as mailing and faxing correspondence, data entry, scheduling, etc.

· Acquire/Exhibit/Maintain subject matter expertise in the area of the liver disease, including but not limited to the condition, treatment, community of patients and caregivers, activities and events offered throughout the country, etc., to ensure staff is providing the appropriate support / service(s)

· Apply subject matter expertise to drive program offerings

Job Qualifications:


Required: Associates degree or equivalent work experience is required

3 - 5 years in pharmacy, managed care, Medicaid and/or Medicare organizations, pharmaceutical and/or biotech manufacturer, medical office, or related similar field

Preferred: Bachelor’s degree

1 years within Specialty Medical Practice – ie. GI, infusion, oncology, eye care


Social workers

Patient Advocates

Case workers / Case managers

Buy and bill background

· Prior experience with scheduling patients

· Knowledge of Medical Terminology

· Working knowledge or experience with resolving drug reimbursement issues

· Knowledge of HCPCS, CPT and ICD-9/10 billing and/or coding

· Certification as Pharmacy Technician is plus

· Knowledge of US private and government payors

· Working knowledge of Microsoft Office (Word, Excel, Outlook)


· Required:

· Curiosity

· Empathy

· Problem Solving

· Swift Investigation

· Initiative

· Analytics

· Effective Listening

· Elaborate Thinking

· Excellent Communication Skills (oral and written)

· Use of / Access to Resources

· Bi-lingual (English / Spanish – Native)

· Ability to Present and Facilitate

· Customer focused

o Fast and accurate data entry

o Clear, pleasant speaking voice

o Ability to handle multiple tasks and troubleshoot issues

o Ability to work with little or no supervision

· Ability to adapt quickly to changing environment

o Team player/consensus builder

o Ability to interact with a diverse group

o Project management skills

· Ability to calculate figures such as discounts and percentages

o Able to work a rotational shift between the hours of 7:45am and 8:15pm – Mon to Fri

Xerox is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, sex, marital status, sexual orientation, physical or mental disability, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law. People with disabilities who need a reasonable accommodation to apply or compete for employment with Xerox may request such accommodation(s) by sending an e-mail to . Be sure to include your name, the job you are interested in, and the accommodation you are seeking.

Job: Service Delivery Healthcare

Organization: IPAS

Title: Sr. Reimbursement Specialist, Case Manager

Location: New Jersey-Somerset

Requisition ID: 16030609

Virtual/work from home? No