Senior Reimbursement Specialist – Evening Shifts

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

📋 Description

• Perform benefit investigations and confirm insurance coverage for both patients and physicians’ offices.

• Submit and secure prior authorizations, along with obtaining recertifications for prolonged treatment or coverage.

• Precisely enter and manage data within the client database and patient records.

• Keep track of outstanding items on client case files and ensure all files are comprehensive.

• Engage in conference calls with Client Sales Representatives, client management, and physicians’ offices.

• Oversee product orders, coordinate product shipments, and facilitate therapy initiation with pharmacies and patients.

• Take part in call center operations and triage incoming calls from patients, insurers, physicians, sales representatives, pharmacies, and homecare agencies.

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

• Identify and document events mandated by REMS requirements.

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

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

• Uphold housekeeping, quality, production, safety, and environmental standards.

• Provide customer service and support reimbursement processes to facilitate patient access to client products and enhance reimbursement.

⛳️ 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 in health insurance claims or patient accounting is a plus.

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

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

• Capability to manage multiple priorities and adhere to deadlines.

• Detail-oriented with strong analytical skills.

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

• Willingness and ability to travel as needed.

• Must be available to work a full-time schedule from 11:00 AM to 8:00 PM Eastern Time, Monday through Friday.

• Candidates located outside the Eastern Time Zone must be able to work the assigned shift aligned with Eastern Time business hours.

🏝️ Benefits

• Opportunities for remote work.

• Competitive salary packages.

• Advancement opportunities for career growth.

• 401K plan with company matching.

• Tuition reimbursement programs.

• Flexible working environment.

• 20 days of paid time off (PTO).

• Employee assistance programs.

• Comprehensive medical, dental, and vision coverage.

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

• Telemedicine services (virtual doctor appointments).

• Wellness initiatives.

• Adoption assistance programs.

• Short-term disability coverage.

• Long-term disability coverage.

• Life insurance benefits.

• Discount programs available.