Government Programs & Providers Specialist
Government Programs & Provider Support Specialist
San Mateo, CA (Hybrid: 3 days onsite, 2 days remote)
An innovative global specialty pharmaceutical company is seeking a Government Programs & Provider Support Specialist to join its North American Operations team. This individual will serve as a key resource for providers, specialty centers, patients, and government stakeholders, supporting reimbursement, access, and operational processes that help ensure timely patient access to therapy. The role offers the opportunity to work across patient access, reimbursement, provider support, and government programs within a growing organization dedicated to improving patient outcomes.
Responsibilities:
- Serve as a reimbursement and access resource for Specialty Centers, providers, patients, and government stakeholders.
- Support billing, claims processing, appeals, reimbursement issue resolution, benefit verification, and prior authorizations.
- Provide guidance on payer coverage requirements, reimbursement policies, and access processes across commercial and government health plans.
- Act as a liaison between Specialty Centers and internal stakeholders to resolve inquiries and support patient access.
- Assist with training Specialty Center billing teams on coding, reimbursement, and claims management processes.
- Coordinate CMS data collection, reporting, and compliance-related activities.
- Maintain provider network resources and support territory planning initiatives.
- Ensure compliance with CMS, OIG, HIPAA, and company policies.
Qualifications:
- Bachelor's degree Required
- 3+ years of experience in pharmaceutical reimbursement, medical billing, managed care, provider operations, or patient access.
- Experience with Medicare Part B, Medicaid, and government payer reimbursement programs.
- Knowledge of prior authorizations, benefit verification, claims processing, and payer coverage requirements.
- Familiarity with CPT, HCPCS, ICD-10, and J-code billing and coding practices.
- Experience using EHR/EMR platforms such as Epic, Cerner, or similar systems.
- Strong understanding of CMS regulations and healthcare reimbursement processes.
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