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The Field Reimbursement Manager is part of the Market Access group supporting Sun’s family of branded products in the United States. The Field Reimbursement Manager will interact with access services hub, managed markets team supporting patient access and local field sales teams.
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Some jurisdictions may require the ability to be fluent in English and Spanish- Review patient files for completeness and accuracy, identify and audit claims, ensure all revenue opportunities are included, and complete and submit billing, primary and secondary, to payers for reimbursement, via paper bills and clearing house submittals.
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The Reimbursement Specialist is responsible for managing outstanding worker's compensation claims by collecting payments, resolving billing issues, and minimizing the number of uncollectable accounts.
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In accordance with the accepted standards and practices of physician billing entities, to represent the physicians of the Tulane University Medical Group in the realization of all appropriate reimbursement for medical services rendered to patients.
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In the event a patient access barrier or reimbursement issue is unable to be immediately resolved, effectively triage and elevate to appropriate internal Eisai personnel or external hub vendor for additional action.
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Work in association with all areas of the Tulane University Medical Group Business Services, partners, Tulane University Hospital and Clinic Staff, and other internal and external persons. Knowledge of IDX physicians billing software is a major asset.
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Demonstrated relevant experience in claims reimbursement preferred, including billing and coding; managed care coverage processes and practices; distribution and dispensing of specialty pharmaceuticals; and relevant aspects of patient support/hub services.
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Serves as resource to hospital management on managed care reimbursement-related matters and keeps abreast of new and proposed health care laws and regulations. Proficiency in Generally Accepted Accounting Principles and ability to conduct healthcare financial analysis, produce financial reports and effectively engage in third party reimbursement accounting.
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The Sr. Reimbursement Analyst will support activities related to data collection, reconciliation, analysis and reporting for the client data management and reporting team. Knowledge of inpatient reimbursement terms and methodologies.
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