Senior Reimbursement Specialist

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

📋 Description

• Perform outbound communications with insurance payers to finalize Pharmacy Benefit Manager (PBM) and Medical Management (MM) benefit verifications.

• Execute benefit investigations and validate insurance benefits for patients as well as physicians' offices.

• Submit and acquire prior authorizations as mandated by payers.

• Secure recertification for cases that necessitate prolonged treatment or coverage.

• Precisely input and uphold data within the client database and patient records.

• Track outstanding items on client case files and ensure that all files are complete.

• Engage in conference calls with Client Sales Representatives, client management, and physicians' offices regarding case updates, drug orders, and alternative funding options.

• Organize product orders, shipments, and therapy initiation in collaboration with pharmacies and patients.

• Take part in call center operations, including triaging and addressing incoming calls.

• Act as a primary point of contact for a designated group of prescribers as required.

• Identify and document events in compliance with REMS requirements.

• Recognize adverse events, product quality concerns, and potential risk occurrences, forwarding information for manufacturer reporting.

• Provide education to patients, prescribers, and others regarding program requirements while facilitating referrals.

• Uphold quality and production standards while adhering to company, state, and federal safety and environmental protocols.

⛳️ Requirements

• High School Diploma/GED or equivalent experience.

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

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

• Proficiency in MS Office applications, with database experience being an advantage.

• Exceptional written and verbal communication skills, with a proven ability to engage with individuals at all levels.

• Capability to handle multiple priorities and adhere to deadlines.

• Detail-oriented with strong analytical skills.

• Familiarity with third-party billing, coding, medical terminology, prior authorizations, and appeals is preferred.

• A HIPAA-compliant workspace is necessary.

• Reliable high-speed internet connection required.

• Availability from Monday to Friday, 9:00 AM–6:00 PM EST, with no flexibility in the schedule.

🏝️ Benefits

• Remote work opportunities.

• Competitive salary packages.

• Opportunities for professional advancement.

• 401K plan with company matching*

• Tuition reimbursement programs.

• Flexible work environment.

• 20 days of paid time off (PTO).

• Paid holidays.

• Employee assistance programs.

• Coverage for medical, dental, and vision.

• Health Savings Account (HSA)/Flexible Spending Account (FSA).

• Telemedicine services (Virtual doctor appointments).

• Wellness programs.

• Assistance with adoption.

• Short-term and long-term disability coverage.

• Life insurance options.

• Discount programs.

• UBC will supply all necessary equipment, including desktop hardware and software.