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 healthcare providers.

• Submit and secure prior authorizations as mandated by payers.

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

• Precisely enter and maintain information in client databases and patient files.

• Track outstanding items on client case files and ensure their completeness.

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

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

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

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

• Identify and report events as required by REMS obligations.

• Recognize adverse events, product quality issues, and potential risks, forwarding information for manufacturer reporting.

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

• Uphold housekeeping, quality, productivity, 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.

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

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

• Outstanding written and verbal communication skills, demonstrating the ability to interact with individuals at all levels.

• Capability to manage multiple priorities and adhere to deadlines.

• Detail-oriented with strong analytical skills.

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

• Adherence to relevant company, state, and federal safety and environmental policies and procedures.

🏝️ Benefits

• Remote work options available.

• Competitive salary packages.

• Opportunities for career advancement.

• 401K plan with company matching.

• Tuition reimbursement options.

• Flexible work environment.

• Discretionary Paid Time Off (PTO) or 20 days 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 appointments).

• Wellness program.

• Adoption assistance.

• Short-term disability coverage.

• Long-term disability coverage.

• Life insurance options.

• Discount programs.