Senior Reimbursement Specialist

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

📋 Description

• Deliver exceptional customer service to patients, their families, national payers, home care providers, and medical offices.

• Perform benefit investigations and confirm insurance coverage for patients and medical practices.

• Submit and secure prior authorizations as mandated by payers.

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

• Precisely input and manage data within client databases and patient records.

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

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

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

• Participate in call center operations and prioritize incoming calls.

• Act as a single point of contact for designated prescribers when necessary.

• Identify and document events as required by REMS guidelines.

• Detect adverse events, product quality concerns, and potential risk situations, and relay information for manufacturer reporting.

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

• Facilitate referrals as needed.

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

⛳️ Requirements

• High School Diploma/GED or equivalent experience required.

• 4–6 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 an advantage.

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

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

• Capacity to manage multiple tasks and meet deadlines effectively.

• Detail-oriented with strong analytical capabilities.

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

• Must adhere to all relevant company, state, and federal safety and environmental policies and procedures.

🏝️ Benefits

• Remote work opportunities available.

• Competitive salary packages.

• Opportunities for career advancement and promotion.

• 401K plan with company matching.*

• Tuition reimbursement programs.

• Flexible work environment.

• 20 days of paid time off (PTO).

• Paid holidays.

• Employee assistance programs.

• Comprehensive medical, dental, and vision insurance.

• Health Savings Account (HSA) and Flexible Spending Account (FSA) options.

• Telemedicine services (virtual doctor appointments).

• Wellness program initiatives.

• Adoption assistance programs.

• Short-term disability benefits.

• Long-term disability insurance.

• Life insurance coverage.

• Employee discount programs.