Reimbursement Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Execute reimbursement tasks, including benefit investigations, prior authorization assistance, and call triage.

• Address inquiries related to provider accounts.

• Record interactions with providers, payers, and clients in the CareMetx Connect system.

• Gather necessary information for prior authorization requests.

• Collect and assess patient insurance benefit details.

• Support physician office personnel and patients with insurance documentation and program applications.

• Complete and submit required insurance forms for third-party payors related to prior authorizations.

• Monitor and follow up on prior authorization submissions.

• Deliver customer service, resolving or escalating inquiries and complaints as needed.

• Maintain communication with provider representatives, third-party customer service agents, and pharmacy staff.

• Report reimbursement trends and delays to management.

• Handle insurance and patient correspondence.

• Provide necessary documentation to expedite prior authorization requests, including demographics, authorizations/referrals, NPI numbers, and referring physicians.

• Collaborate with inter-departmental associates.

• Engage with payors to guarantee accurate and timely benefit investigations.

• Analyze moderately complex issues and determine suitable actions in accordance with standard operating procedures.

• Report adverse events following training and established protocols.

• Maintain a consistent and reliable attendance record.

• Perform additional related duties as assigned.

⛳️ Requirements

• High School Diploma or GED is mandatory.

• At least 1 year of experience in a specialty pharmacy, medical insurance, physician’s office, healthcare environment, or related field.

• Strong oral and written communication skills.

• Capability to cultivate productive internal and external working relationships.

• Excellent interpersonal abilities.

• Proficient negotiation skills.

• Strong organizational capabilities and attention to detail.

• General understanding of pharmacy and medical benefits.

• Preferred global understanding of commercial and government payers.

• Proficiency in Microsoft Excel, Outlook, and Word.

• Ability and initiative to work independently or collaboratively as part of a team.

• Problem-solving skills.

• Excellent time management abilities.

• Focus on customer satisfaction.

• Flexibility with schedule and hours is essential.

• Occasional overtime may be necessary.

• Willingness to work weekends if required to meet company demands.

• Equivalent combinations of experience and education will be considered.

🏝️ Benefits

• Flexible scheduling and hours.

• Opportunities for overtime as needed.

• Equal employment opportunity protections.

• Reasonable accommodations for individuals with disabilities.