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 both patients and physician offices.

• Process and secure prior authorizations while managing recertifications for extended treatment or coverage.

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

• Track outstanding tasks and ensure that files are complete and up-to-date.

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

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

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

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

• Identify and report incidents as mandated by REMS requirements.

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

• Educate patients, prescribers, and others on program requirements and facilitate necessary referrals.

• Uphold cleanliness, quality, productivity, safety, and environmental standards.

⛳️ Requirements

• High School Diploma/GED or equivalent experience.

• 4–6 years of experience in 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.

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

• Capability to handle multiple priorities and adhere to deadlines.

• Detail-oriented with strong analytical abilities.

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

🏝️ Benefits

• Opportunities for remote work.

• Competitive salary packages.

• Promotion and growth opportunities.

• 401K plan with company matching.

• Tuition reimbursement program.

• Flexible work environment.

• 20 days of paid time off (PTO).

• Paid holidays.

• Employee assistance programs.

• Comprehensive medical, dental, and vision insurance coverage.

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

• Telemedicine services (virtual doctor appointments).

• Wellness programs.

• Adoption assistance benefits.

• Short-term and long-term disability coverage.

• Life insurance options.

• Discounts through various programs.