Payor Analyst - Reimbursement HUB Services

As a pharmaceutical support industry leader, UBC is devoted to empowering health solutions for a better tomorrow. We take pride in improving patient outcomes and advancing healthcare. At UBC we provide services to enhance the entire drug development process and commercialization lifecycle - From clinical trial support to real-world evidence generation.

Embark on a rewarding career journey with UBC! Grow your career while making a meaningful impact on the world around you. UBC fosters a culture built on our Core Values being: Collaborative, Conscientious, Curious, Consultative, and Compassionate. We believe in an inclusive workplace that fosters creativity.

If you are seeking a career that will challenge, inspire, and reward you, join us at UBC! 

Brief Description: 

The Payer Procedures and Communications Specialist is responsible for maintaining critical system files, included but not limited to Referring Doctor Files, Insurance Databases Files, and other applicable reference tools that support the reimbursement process. Additionally assisting the audit team by pulling necessary documentation for audit or deep dive requests as needed. (i.e. internal, external, Onsite audits, Medicaid, PDE, etc.). 
 

Specific job duties:

• Responsible for the Payer Information Management System Database File Maintenance. This means understanding the reimbursement process and how the data contained in these files can be used to support the process and how to effectively change and clean files. Including but not limited to: Referring Healthcare Professional Files - Insurance Database to include but not limited to; payer processing information, specific PA and Appeal requirements, key contact information, appropriate form, and payer best practices. 
• Serve as point person in collecting and validating new insights as they emerge from cross-functional team members (the hub, field reimbursement team, market access team, and analytics team) on payer policies, requirements and review process nuances 
• Act as a cross-functional liaison regularly connecting with other functions to understand and disseminate knowledge changes in payer policies/requirements/processes 
• Clean and update current system files 
• Receive payer notices and updates through a variety of means, load to payer database (as appropriate) and keep staff informed of payer changes
• Ensure that necessary departments are notified of changes, and maintain a file of payer changes or notices for future reference 
• Work with appropriate operations groups to create payer roadmaps that help guide users to appropriate billing/PA/Appeal documentation and procedures based on the prescribed treatment. 
• Assist Quality team in pulling necessary documentation as needed for different types of audit requests and prepares presentation of progress and presents to client in meetings such as monthly business or quarterly business reviews. 
• Assist with educating staff on departmental policies and procedures, which may include providing instruction on how to maximize first submission success. 
• Serve as a SME for operations to help educate clients on best practices. 
• Partner with client stakeholders to receive and share intelligence on payer trends and changes. 
• Participate in Payer Focus Groups or other applicable meetings to share and identify payer nuances or trends
• Provide insights or key learnings to internal and client stakeholders ongoing and as needed. 
• Prepare and work with leadership to communicate updates to hub stakeholders, work with Quality to ensure that learnings are pulled through in practice. 

Supervisory Responsibility: 

N/A

Desired Skills and Qualifications:

• 5+ years of professional work experience required. 
• Payer experience with a specific background in healthcare reimbursement, PBM, or hospital setting strongly preferred. 
•  3+ years of MS Office experience. 

Preferred Qualifications 

• Background in Health Care or Reimbursement with 1-3 years auditing and quality assurance work experience. 
• Knowledge of insurance plans including government payers, i.e. Medicaid, Medicare, and Tricare. 
• Organizes work assignments, set priorities and completes work with minimum supervision. 
• Knowledge and skills to understand insurance benefits including but not limited to the prior authorization and appeal process. 
• Experience in medical terminology- 1-3 years related Industry experience and/or training; or equivalent combination of education and experience 
• Demonstrated leadership capabilities
• Demonstrated ability to handle multiple tasks simultaneously and to prioritize accordingly 
• Proven ability to work with a high degree of accuracy and attention to detail 
• Demonstrates core competencies of: attention to detail, organization skills, ability to prioritize and follow up, effective communication and ownership for one’s work 
• Proficient in Excel, Access, Word and Power Point 
• Strong written and verbal communication skills, including an ability to interact with internal/external business partners in person or by phone 
• Able to work effectively with other internal/external functional departments 
• Education High School Diploma or GED required

At UBC, employee growth and well-being are always at the forefront. We offer an extensive range of benefits to ensure that you have everything you need to thrive personally and professionally. 

Here are some of the exciting perks UBC offers: 

• Remote opportunities
• Competitive salaries
• Growth opportunities for promotion
• 401K with company match*
• Tuition reimbursement
• Flexible work environment
• Discretionary PTO (Paid Time Off) 
• Paid Holidays
• Employee assistance programs 
• Medical, Dental, and vision coverage
• HSA/FSA
• Telemedicine (Virtual doctor appointments)
• Wellness program
• Adoption assistance
• Short term disability
• Long term disability
• Life insurance
• Discount programs

UBC is proud to be an equal opportunity employer and does not discriminate because of race, color, sex, age, national origin, religion, sexual orientation, gender identity and/or expression, status as a veteran, and basis of disability or any other federal, state, or local protected class. We are committed to a diverse, equitable and inclusive culture that fosters respect for each other, our clients, and our patients.

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