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 physician offices.

• Submit and secure prior authorizations and re-certifications for ongoing treatment or coverage.

• Input and maintain accurate data in client databases and patient records.

• Track pending items and ensure case files are thoroughly completed.

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

• Coordinate product orders, shipping, and therapy start dates with pharmacies and patients.

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

• Act as a primary point of contact for assigned prescribers when necessary.

• Identify and document events in accordance with REMS requirements.

• Detect adverse events, product quality issues, and potential risks, and relay information for manufacturer reporting.

• Provide education to 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, including customer service and/or reimbursement.

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

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

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

• Capability to handle multiple priorities and adhere to deadlines.

• Detail-oriented with proficient analytical skills.

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

🏝️ Benefits

• Remote work opportunities.

• Competitive salary packages.

• Opportunities for career advancement.

• 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) and Flexible Spending Account (FSA).

• Telemedicine services (virtual doctor visits).

• Wellness initiatives.

• Adoption assistance programs.

• Short-term disability coverage.

• Long-term disability coverage.

• Life insurance benefits.

• Discount programs.