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Specialist, Reimbursement and Appeals

Market Access | Santa Monica, CA | Full Time

Job Description

Kite is a biopharmaceutical company engaged in the development of innovative cancer immunotherapies with a goal of providing rapid, long-term durable response and eliminating the burden of chronic care. The company is focused on chimeric antigen receptor (CAR) and T cell receptor (TCR) engineered cell therapies designed to empower the immune system's ability to recognize and kill tumors. Kite is based in Santa Monica, CA. For more information on Kite, please visit www.kitepharma.com. Sign up to follow @KitePharma on Twitter at www.twitter.com/kitepharma.

The Reimbursement and Appeals Specialist is responsible for managing all reimbursement activities for oncology patients from benefit investigations, prior authorizations, pre-determinations, to appeals. The Reimbursement/Appeals Specialist will be responsible for assisting with gaining coverage for a novel new product in the Oncology space.

 

Responsibilities (include but are not limited to):

  • Verifies patient eligibility and conducts complete benefit investigations
  • Determines best approach when completing prior authorizations / pre-determinations
  • Confirms coverage and identifies any barriers to coverage for a new product
  • Educates the payers regarding the new product and monitors adoption and acceptance of product
  • Identifies and resolves claims / eligibility issues
  • Ensures that all claims submitted to government and private payers comply with applicable federal and state regulations
  • Provides timely follow-up on unpaid, denied, and / or short paid claims
  • Understands and interprets payer guidelines and policies
  • Performs searches for relevant articles and assists the customer through education and clear communication
  • Manages an appeal spreadsheet and notifies the program team and managed care department of payer issues related to appeals
  • Ensures all timelines and customer commitments are met
  • Minimizes obstacles to coverage by using judgment to successfully plan next steps
  • Makes constant case assessments and makes informed, methodical decisions throughout a very complex process
  • Assists customers to navigate healthcare insurance reimbursement issues through education, information, and exceptional communication
  • Supports the Operations Program Manager on program initiatives and departmental goals
  • Enters insurance and benefit data into the program system
  • Responds to internal team member case-related questions
  • Participates in daily informal check-in’s with team
  • Attends weekly team meeting
  • Responds to emails from internal and external customers that need to be addressed immediately by a reimbursement / appeals specialist

 

Requirements:

  • Excellent oral and written communication, and customer service skills
  • Strong writing skills and excellent organizational ability
  • Clinical knowledge is preferable but not essential
  • Proven ability to think strategically and to prioritize
  • Exceptional problem solving skills
  • Exceptional computer skills with proficiency in MS Office Suite, specifically MS Word and Excel
  • Ability to work enthusiastically with others
  • Self-confident and resourceful
  • Exhibits initiative, flexibility, and dependability
  • Quality work and attention to detail
  • Humility and integrity
  • Team Player
  • Customer-focused
  • Business acumen / business savvy
  • Three or more years of reimbursement experience preferably in a pharma / biotech or health services environment specializing in oncology
  • Proficiency in healthcare insurance reimbursement including benefit investigation and design, prior authorizations and pre-determinations
  • Full understanding of the insurance approval / denial / appeals process; previous direct experience in submitting appeals and advocating for appropriate clinical treatment of patients is highly desired
  • Experience navigating through the public and private payers and working through managed care systems
  • BA degree preferred

 

Kite Pharma is an equal opportunity employer based in Santa Monica, CA. Kite Pharma offers the opportunity to be part of a successful, fast growing company in a cross functional and collaborative environment.       

To learn more about us, please visit our website at www.kitepharma.com

No phone calls please and no agencies or recruiters.