Healthcare Benefits Specialist l (Onsite, Laguna Hills, CA)

About AmeriPharma

AmeriPharma is a highly rated closed-door pharmacy making a positive impact on the lives of our patients every day. Our family of brands provides long-term pharmacy care at home. That includes nursing services with CorsanaCare, AmeriPharma Infusion Centers, AmeriPharma Specialty Care, and MedBox, a pharmacy made for seniors.

We're looking for candidates who want to grow with us as our customer demand grows. We're constantly improving the way we work, investing in innovative technology for our future, and striving to modernize pharmacy operations – a rare thing in our industry.  If you want to grow your career in a supportive and transparent environment where people are respected, customers come first, and effort is recognized, this might be the role for you.

(Remote work is not an option at this time.)

AmeriPharma’s Benefits

• Full benefits package including medical, dental, vision, life that fits your lifestyle and goals
• Great pay and general compensation structures
• Employee assistance program to assist with mental health, legal questions, financial counseling etc.
• Comprehensive PTO and sick leave options
• 401k program
• Plenty of opportunities for growth and advancement
• Company sponsored outings and team-building events
• Casual Fridays 

Job Summary

The Healthcare Benefits Specialist l supports the Patient & Revenue Retention Manager in the financial review process, ensuring cost-effectiveness by analyzing new referrals, existing patients’ health plan fee schedules, and other reimbursement databases. Key responsibilities include evaluating payer reimbursement methodologies, reviewing patient insurance benefits, and educating patients about available drug brands and copayment assistance programs. This position is designed to enhance patient onboarding and ongoing care by ensuring new and existing patients are informed of all available healthcare benefit options.

Experience in reviewing reimbursement from different payors according to insurance benefits and coverage for high cost therapies across all lines of business - commercial vs government, pharmacy vs medical benefits, knowledge of Medicare coverage for Home Infusion Therapy is a plus.  

Schedule Details

Location: On-Site (Laguna Hills, CA)

Hours: Monday-Friday, 7:30am to 4:00pm PST

Duties and Responsibilities

• Assist with the reimbursement review and determination process within specialty operations.
• Review new referrals to ensure cost-effectiveness based on payer fee schedules and/or contracted rates, utilizing both In/Out-of-Network benefits from the patient’s health plan.
• Generate ad-hoc reports on profitability, cancellations, and other relevant categories.
• Educate and guide patients on AmeriPharma's products and services, including financial assistance options when applicable.
• Provide clear explanations of healthcare insurance benefits, including coverage details, copayments, deductibles, and network restrictions.
• Accurately document patient interactions, insurance details, and other relevant information in the electronic health record (EHR) system.

Required Qualifications

Our goal is to ensure excellent patient care...

• Analytical, forward & critical thinking, resourceful, team player, strong patient care and customer service skills.
• Punctuality and reliable attendance is critical to the success of this role.
• Strong business acumen, problem-solving, and analytical skills.
• Knowledge of medical and pharmacy reimbursement methodologies.
• Familiarity with various types of health insurance benefits and patient access/copayment assistance programs in the marketplace.

Education and Experience Requirements

• Associate's degree.
• Minimum of 2 years of experience in specialty pharmacy setting is preferred.
• Minimum of 2 years of experience with payer reimbursement methodologies within the healthcare revenue specialty reimbursement industry; experience with Medicare Part B & D is preferred.

AmeriPharma’s Mission Statement 

Our goal is to achieve superior clinical and economic outcomes while maintaining the utmost compassion and care for our patients. It is our joint and individual responsibility daily to demonstrate to outpatients, prescribers, colleagues, and others that We Care!

Physical Requirements 

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is continuously required to sit and talk or hear. The employee is occasionally required to stand; walk; use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; and stoop, kneel, crouch or crawl. The employee must regularly lift and/or move up to 20 pounds and occasionally lift/or move up to 30 pounds. Specific vision abilities required by this job include close vision, peripheral vision, depth perception and the ability to adjust focus.

EEO Statement 

The above statements are intended to describe the work being performed by people assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties and skills required. The duties and responsibilities of this position are subject to change and other duties may be assigned or removed at any time. AmeriPharma values diversity in its workforce and is proud to be an AAP/EEO employer. All qualified applicants will receive consideration for employment without regard to race, sex, color, religion, sexual orientation, gender identity, national origin, age, protected veteran status, or based on disability or any other legally protected class.