Houston Methodist is honored to announce that we have been ranked #3 on Forbes' America's Best Large Employers 2025 list, making us the top-ranked healthcare organization in the nation. This marks the sixth year we have received this prestigious recognition, a testament to our unwavering commitment to fostering a workplace …
Reimbursement Coordinator - Specialty Pharmacy - Hybrid
Location:
HMWB Hargrave - 13300 Hargrave Houston, Texas 77070
- Job Ref:
- 67542
- Talent Area:
- Administrative
- Job Shift:
- 1st - Day
- Job Type:
- Full-Time
- Posted Date:
- Feb. 25, 2025
At Houston Methodist, the Reimbursement Coordinator position is responsible for maximizing reimbursement opportunities within the pharmacy department and hospital. This position performs activities that include but are not limited to drug replacement programs, co-pay assistance programs, insurance verification for high-cost drugs and/or restricted drugs, and denial prevention management. This position also maintains data/documents and provides accounting of results.
Requirements:
PEOPLE ESSENTIAL FUNCTIONS
- Promotes a positive work environment and contributes to a dynamic, team-focused work unit that actively helps one another to achieve optimal department results. Collaborates with other health care professionals as needed for problem resolution and/or achievement of identified patient specific goals.
- Establishes business relationships with appropriate hospital financial staff and other pertinent hospital departments as required.
SERVICE ESSENTIAL FUNCTIONS
- Maintains and updates changes for patients participating in the assistance medication recovery program.
- Develops and maintains all components of the reimbursement process, including key hospital departments.
QUALITY/SAFETY ESSENTIAL FUNCTIONS
- Assists with the development of drug recovery reimbursement policies and procedures pertinent to the area drug recovery.
- Ensures all drug recovery received is properly documented; maintains files and documentation of claim submittals.
FINANCE ESSENTIAL FUNCTIONS
- Monitors trends and reasons for denied claims and takes action to resolve issues that interfere with drug recovery reimbursement.
- Maintains database comprised of receivables, problems, standard forms, letters and manufacturers that offer medication patient assistance reimbursement programs.
- Tracks, documents, and reports cost savings associated with patient assistance drug recovery programs, and provides updates to pharmacy management on medication reimbursement opportunities.
- Optimizes reimbursement opportunities through insurance verification of high-cost drugs.
GROWTH/INNOVATION ESSENTIAL FUNCTIONS
- Identifies opportunities to enhance the prior authorization process and opportunities to increase cost-savings for patients.
- Seeks opportunities to expand learning beyond baseline competencies with a focus on continual development as a Reimbursement Coordinator.
This job description is not intended to be all-inclusive; the employee will also perform other reasonably related business/job duties as assigned. Houston Methodist reserves the right to revise job duties and responsibilities as the need arises.
Qualifications:
EDUCATION
- High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.)
WORK EXPERIENCE
- Four years of relevant experience in areas such as pharmacy, clinical documentation, coding, social services, scheduling, insurance and/or patient accounting
LICENSES AND CERTIFICATIONS - REQUIRED
- N/A
KNOWLEDGE, SKILLS, AND ABILITIES
- Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations
- Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security
- Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles
- Significant planning, problem solving, and complex decision making skills to ensure optimized financial outcomes
- Proficient computer knowledge and computer systems such as MS Word and Excel; proficiency in Health Information Management Systems, and SPSS or SAS is preferred
- Exhibits strong interpersonal and team player skills with all levels of the healthcare team and assures delivery of excellent customer service to all patients, visitors, physicians and co-workers
SUPPLEMENTAL REQUIREMENTS
WORK ATTIRE
- Uniform No
- Scrubs Yes
- Business professional Yes
- Other (department approved) Yes
ON-CALL*
*Note that employees may be required to be on-call during emergencies (ie. DIsaster, Severe Weather Events, etc) regardless of selection below.
- On Call* No
TRAVEL**
**Travel specifications may vary by department**
- May require travel within the Houston Metropolitan area Yes
- May require travel outside Houston Metropolitan area No
Company Profile:
Houston Methodist is one of the nation’s leading health systems and academic medical centers. Houston Methodist consists of eight hospitals: Houston Methodist Hospital, its flagship academic hospital in the heart of the Texas Medical Center, and seven community hospitals throughout the greater Houston area. Houston Methodist also includes an academic institute, a comprehensive residency program, a global business division, numerous physician practices and several free-standing emergency rooms and outpatient facilities. Overall, Houston Methodist employs more than 27,000 employees and is supported by a wide variety of business functions that operate at the system level to help enable clinical departments to provide high quality patient care.
Houston Methodist is an Equal Opportunity Employer.
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