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The Access Solutions Reimbursement Specialist investigates patient’s 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.

Key Responsibilities/Accountabilities

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 payer’s 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.

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
Achieving Results
Operating Principles

I always act as if patients I know are in the room and do what’s best for them.
I seek answers through experiments, data and debate, and act on facts.
I care, collaborate and commit without boundaries, and trust others to do their part.
I seek diverse perspectives, invite opposing views, and challenge myself and others.
I push to learn new things even if difficult, and openly share my successes and failures.
I eliminate complexity, reuse with pride, and accomplish more with less.
I take accountability to do what’s right, deliver value fast, and don’t wait for certainty.
I choose actions today that benefit future generations.

Contractors will be employees of ProUnlimited, assigned to Genentech.

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