Senior Reimbursement Specialist

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

📋 Description

• Perform benefit investigations and validate insurance benefits for patients and healthcare providers.

• Submit and secure prior authorizations as mandated by insurance payers.

• Obtain recertification for cases requiring prolonged treatment or coverage.

• Accurately input and manage data in client databases and patient records.

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

• Engage in conference calls regarding case status, medication orders, and alternative funding options.

• Coordinate product orders, shipments, and therapy initiation with pharmacies and patients.

• Participate in call center operations and triage incoming calls.

• Act as a primary contact for designated prescribers.

• Identify and report events as required by REMS regulations.

• Recognize adverse events, product quality complaints, and potential risk events, forwarding them for reporting.

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

• Facilitate referrals.

• Uphold housekeeping, quality, production, safety, and environmental standards.

⛳️ 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 preferred.

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

• Proficiency in MS Office applications; database experience is an advantage.

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

• Capacity to manage multiple priorities and adhere to deadlines.

• Detail-oriented with strong analytical abilities.

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

• Ability to adhere to applicable company, state, and federal safety and environmental protocols and procedures.

🏝️ Benefits

• Remote work opportunities.

• Competitive salary packages.

• Opportunities for career advancement and promotion.

• 401K plan with company matching.

• Tuition reimbursement options.

• Flexible working environment.

• Discretionary PTO (Paid Time Off) or 20 days of PTO.

• Paid holidays.

• Employee assistance programs.

• Comprehensive medical, dental, and vision coverage.

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

• Telemedicine services (Virtual doctor appointments).

• Wellness programs.

• Adoption assistance programs.

• Short-term disability coverage.

• Long-term disability coverage.

• Life insurance options.

• Discount programs.