Senior Reimbursement Specialist – Fixed Term

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

📋 Description

• Perform benefit investigations and validate insurance benefits for patients and healthcare providers.

• Submit requests for prior authorizations and recertifications to payers for extended treatment or coverage.

• Input and manage information in client databases and patient records.

• Track pending items and ensure that case files are thorough and complete.

• Engage in conference calls with Client Sales Representatives, management, and healthcare providers.

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

• Participate in call center operations and manage incoming calls from patients, insurers, healthcare providers, sales representatives, pharmacies, and homecare agencies.

• Act as the primary point of contact for designated prescribers.

• Identify and report events in accordance with REMS requirements.

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

• Provide education to patients, prescribers, and others regarding program requirements and 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; experience in customer service and/or reimbursement is preferred.

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

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

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

• Capable of managing multiple priorities and adhering to deadlines.

• Detail-oriented with strong analytical abilities.

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

• Must adhere to relevant company, state, and federal safety and environmental regulations and protocols.

🏝️ Benefits

• Remote work opportunities.

• Competitive salary packages.

• Opportunities for career advancement.

• 401K plan with company matching.

• Tuition reimbursement available.

• Flexible working environment.

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

• Paid holidays.

• Employee assistance programs.

• Medical, dental, and vision insurance coverage.

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

• Telemedicine services (virtual doctor appointments).

• Wellness programs.

• Adoption assistance.

• Short-term disability insurance.

• Long-term disability insurance.

• Life insurance coverage.

• Employee discount programs.