Senior Reimbursement Specialist

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

📋 Description

• Deliver exceptional customer service.

• Effectively communicate with patients, their families, national payers, home care services, and medical offices to support patients and medical providers in streamlining processes.

• Conduct benefit investigations, verify insurance coverage for patients and physicians, and submit and secure prior authorizations as necessary for payers.

• Acquire recertification for cases that require extended treatment or coverage beyond the initial approval period.

• Precisely input and maintain data as required within the client database and patient files.

• Leverage the client database to track outstanding items for each client case file.

• Ensure that files are complete to allow the team to assess the current status.

• Engage in conference calls as needed with Client Sales Representatives, client management, and physicians' offices regarding the status of cases, drug orders, and alternative funding updates.

• Coordinate orders for products, manage product shipments, and facilitate therapy initiation with pharmacies and patients.

• Participate in Call Center Activities, triaging and responding to incoming calls from patients, insurance companies, physicians, Sales Representatives, pharmacies, and home care agencies.

• May act as the primary point of contact for a designated group of prescribers.

• Identify and report events as mandated by the REMS requirements for specific medications.

• Recognize adverse events, product quality complaints, and potential risk events, forwarding details to the appropriate team member for reporting to the manufacturer.

• Educate patients, prescribers, and others on program requirements and facilitate referrals.

• Maintain effective housekeeping practices, adhere to quality and production standards, and comply with all relevant company, state, and federal safety and environmental regulations.

⛳️ Requirements

• High School Diploma/GED or equivalent experience.

• 4 to 6 years of experience in the insurance, biotechnology, or pharmaceutical sectors; customer service and/or reimbursement experience is essential.

• Experience with health insurance claims or patient accounting is a plus.

• Proficiency in MS Office applications; experience with databases is advantageous.

• Excellent written and verbal communication abilities, with a proven capacity to engage with individuals at all levels.

• Capability to manage multiple priorities and meet deadlines effectively.

• Detail-oriented with strong analytical skills.

• Preferred knowledge of third-party billing, coding, medical terminology, prior authorizations, and appeals.

🏝️ Benefits

• Remote work opportunities.

• Competitive salary packages.

• Opportunities for career advancement.

• 401K plan with company matching.*

• Tuition reimbursement options.

• Flexible work environment.

• Discretionary PTO (Paid Time Off) OR 20 days PTO.*

• Paid holidays.

• Employee assistance programs.

• Comprehensive medical, dental, and vision coverage.

• Health Savings Account/Flexible Spending Account.

• Telemedicine services (virtual doctor appointments).

• Wellness program initiatives.

• Adoption assistance programs.

• Short-term disability insurance.

• Long-term disability insurance.

• Life insurance coverage.

• Discount programs available.