What are the responsibilities and job description for the Spravato Insurance & Billing Specialist position at Anew Therapy?
Job Summary
Anew Therapy is seeking a detail-oriented and experienced Part-Time Spravato® Insurance & Billing Specialist to manage all aspects of pre-authorizations, insurance billing, and prescription submissions for patients receiving Spravato® (esketamine) treatments. This role will ensure that all processes align with REMS (Risk Evaluation and Mitigation Strategy) requirements and payer policies to provide patients with seamless access to their prescribed treatments.
Qualifications: Must have at least 1 year of experience working with the Spravato program.
Key Responsibilities
Insurance Preauthorizations:
- Initiate, track, and secure insurance preauthorizations for Spravato® treatments.
- Verify patient benefits, eligibility, and coverage details, ensuring compliance with payer requirements.
- Communicate effectively with insurance companies to resolve preauthorization denials or delays.
Insurance Billing & Reimbursements:
- Manage billing processes for Spravato®, ensuring accurate coding and submission to insurance providers.
- Monitor and track reimbursements, identifying and addressing payment discrepancies or denials.
- Coordinate with the billing department to ensure timely claims processing and follow-ups.
Prescription Coordination:
- Submit and manage Spravato® prescriptions through the appropriate REMS-approved pharmacy systems.
- Ensure all patient information is complete and accurate to avoid delays in treatment initiation.
- Collaborate with Janssen representatives and third-party specialty pharmacies to resolve prescription issues.
Compliance & Documentation:
- Maintain meticulous records of preauthorizations, insurance claims, and pharmacy submissions.
- Ensure all processes adhere to REMS program requirements and applicable laws.
- Stay informed on changes in payer policies or REMS guidelines and update workflows accordingly.
Patient Communication:
- Provide patients with clear, concise updates about the status of their preauthorizations and insurance claims.
- Clarify out-of-pocket costs, insurance coverage, and payment expectations.
- Offer support in navigating insurance-related challenges and escalate complex issues when necessary.