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.

• Request and secure prior authorizations and recertifications from payers for ongoing treatment or coverage.

• Input and manage data within client databases and patient records.

• Track pending items and ensure completeness of case files.

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

• Organize product orders, deliveries, and therapy starts in collaboration with pharmacies and patients.

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

• Act as a primary contact for designated prescribers when necessary.

• Recognize and report events as mandated by REMS requirements.

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

• Provide education to patients, prescribers, and others regarding program requirements and assist with 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 preferred.

• Health insurance claims or patient accounting experience is advantageous.

• Proficiency in MS Office applications; experience with databases is a plus.

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

• Capacity to handle multiple priorities and adhere to deadlines.

• Detail-oriented with strong analytical capabilities.

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

• Availability to work Monday through Friday from 8:00 AM to 5:00 PM Eastern Time.

🏝️ Benefits

• Remote work options.

• Competitive salary packages.

• Opportunities for career advancement.

• 401K plan with company matching.

• Tuition reimbursement programs.

• Flexible working environment.

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

• Paid holidays.

• Employee assistance programs.

• Comprehensive medical, dental, and vision coverage.

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

• Telemedicine services (virtual doctor visits).

• Wellness programs.

• Adoption assistance.

• Short-term disability insurance.

• Long-term disability insurance.

• Life insurance coverage.

• Discount programs.