Senior Reimbursement Specialist

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

📋 Description

• Perform benefit investigations and confirm insurance benefits for patients and physician offices.

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

• Enter and maintain data accurately in client databases and patient records.

• Monitor pending items and ensure case files are comprehensive.

• Engage in conference calls with Client Sales Representatives, client management, and physician offices.

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

• Take part in call center operations and manage incoming calls effectively.

• Address inquiries from patients, insurance companies, physicians, Sales Representatives, pharmacies, and homecare agencies.

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

• Identify and report events as per REMS requirements.

• Recognize adverse events, product quality issues, and potential risk factors, forwarding them for manufacturer reporting.

• Provide education to patients, prescribers, and others regarding 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 advantageous.

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

• Exceptional written and verbal communication skills, with a proven ability to communicate effectively across all levels.

• Capability 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.

• Willingness to travel as necessary.

• Must be available to work a full-time schedule from 11:00 AM to 8:00 PM Eastern Time, Monday through Friday.

• Candidates located outside the Eastern Time Zone must be able to work the assigned shift according to Eastern Time business hours.

🏝️ Benefits

• Opportunities for remote work.

• Competitive salary packages.

• Opportunities for career advancement.

• 401K plan with company matching.

• Tuition reimbursement options.

• Flexible working environment.

• 20 days of paid time off (PTO).

• Employee assistance programs available.

• Comprehensive medical, dental, and vision coverage.

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

• Telemedicine services (virtual doctor appointments).

• Wellness programs.

• Adoption assistance services.

• Short-term disability coverage.

• Long-term disability coverage.

• Life insurance options.

• Discount programs available.