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 benefits for patients and physician offices.

• Request and secure prior authorizations as mandated by payers.

• Obtain recertification for cases that necessitate extended treatment or coverage.

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

• Track outstanding items and ensure that files are complete.

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

• Oversee product orders, shipments, and therapy initiation in coordination with pharmacies and patients.

• Participate in call center activities and manage incoming calls from patients, insurance companies, physicians, Sales Representatives, pharmacies, and homecare agencies.

• Act as a single point of contact for a designated group of prescribers as needed.

• Identify and report events as required by REMS regulations.

• Recognize adverse events, product quality issues, and potential risk events, and relay information for manufacturer reporting.

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

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

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

• Strong written and verbal communication skills, with the ability to interact effectively at all levels.

• Capacity to handle multiple priorities and meet deadlines.

• Detail-oriented with strong analytical skills.

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

• 8-hour workday with start times at 9am, 10am, and 11am EST following training.

• Training is available Monday–Friday, 9am–6pm EST for a duration of six weeks.

🏝️ Benefits

• Remote work opportunities.

• Competitive salary packages.

• Opportunities for career advancement and promotion.

• 401K plan with company matching.

• Tuition reimbursement program.

• Flexible working environment.

• 20 days of paid time off (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 program.

• Adoption assistance.

• Short-term disability coverage.

• Long-term disability coverage.

• Life insurance.

• Discount programs.