Senior Reimbursement Specialist

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

📋 Description

• Deliver exceptional customer service.

• Efficiently communicate with patients, their families, national payers, home care services, and medical offices to support patients and healthcare providers in accelerating the initiation process for client products.

• Ensure optimal reimbursement levels are achieved for client products.

• Perform benefit investigations, confirm insurance benefits for patients and physicians' offices, and submit and secure prior authorizations as mandated by payers.

• Obtain recertification for cases that require continued treatment or coverage beyond the initial approval period.

• Accurately input and maintain necessary data in the client database and patient records.

• Utilize the client database to track outstanding items within each client case file.

• Ensure completeness of files to assist the team in determining the current status.

• Engage in conference calls as necessary with Client Sales Representatives, client management, and medical offices regarding case statuses, drug orders, and alternative funding statuses.

• Coordinate the ordering, shipment of products, and therapy initiation with pharmacies and patients.

• Participate in Call Center activities, manage, and respond to incoming calls from patients, insurers, physicians, sales representatives, pharmacies, and home care agencies.

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

• Identify and report events as stipulated by REMS requirements for designated medications.

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

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

• Maintain cleanliness and adhere to quality and production standards, while complying with all relevant company, state, and federal safety and environmental programs and procedures.

⛳️ Requirements

• High School Diploma/GED or equivalent experience.

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

• Experience in health insurance claims or patient accounting is advantageous.

• Proficiency in MS Office applications, with database experience being a plus.

• Outstanding written and verbal communication skills, with a proven ability to interact effectively with individuals at all levels.

• Capability to manage multiple priorities and adhere to deadlines.

• Detail-oriented with strong analytical skills.

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

🏝️ Benefits

• At UBC, the growth and well-being of employees are always prioritized.

• We provide a comprehensive range of benefits to ensure you have everything necessary to thrive both personally and professionally.

• Remote work opportunities.

• Competitive salary packages.

• Opportunities for career advancement.

• 401K plan with company match.*

• Tuition reimbursement program.

• Flexible working environment.

• Discretionary Paid Time Off (PTO) OR 20 days PTO *note: JD should include one or the other.

• Paid holidays.

• Employee assistance programs.

• Medical, dental, and vision coverage.

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

• Telemedicine services (virtual doctor appointments).

• Wellness programs.

• Adoption assistance.

• Short-term disability coverage.

• Long-term disability coverage.

• Life insurance options.

• Discount programs.