Senior Reimbursement Specialist

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

📋 Description

• Perform benefit investigations and verify insurance benefits for patients and medical offices.

• Submit and secure prior authorizations as mandated by payers.

• Acquire 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 medical offices.

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

• Partake in call center operations and manage incoming calls.

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

• Identify and report events as per REMS requirements.

• Recognize adverse events, product quality complaints, and potential risk events, 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 is preferred.

• Health Insurance claims or patient accounting experience is a plus.

• Proficiency in MS Office applications, with database experience being an advantage.

• Exceptional written and verbal communication skills, with a proven 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.

• Adhere to all relevant company, state, and federal safety and environmental programs and procedures.

🏝️ Benefits

• Remote opportunities.

• Competitive salaries.

• Growth opportunities for promotion.

• 401K with company match.

• Tuition reimbursement.

• Flexible work environment.

• 20 days PTO.

• Paid Holidays.

• Employee assistance programs.

• Medical, Dental, and vision coverage.

• HSA/FSA.

• Telemedicine (Virtual doctor appointments).

• Wellness program.

• Adoption assistance.

• Short-term disability.

• Long-term disability.

• Life insurance.

• Discount programs.