Senior Reimbursement Specialist - Specialty Pharmacy

AssistRx•Maitland, FL

About The Position

This role works directly with healthcare and pharmaceutical providers, as well as insurance plans/payers to gather information about a patient’s insurance and the coverage provided for a specific pharmaceutical product. You will support the healthcare providers addressing questions regarding coding and billing and navigating complex reimbursement issues.

Requirements

Strong knowledge of benefit verification and financial assistance programs.
Experience with Salesforce or equivalent CRM tools.
High attention to detail and task completion accuracy.
Effective communication via phone, email, and collaboration tools (Teams).
Ability to manage high-volume caseloads with time-sensitive responsibilities.
Familiarity with HIPAA regulations and patient confidentiality standards.
Previous work experience in Medical and Pharmacy Reimbursement or Customer Service.
Submitting billing data to appropriate insurance providers
Processing claims and resolving denial instances.
Achieving maximum reimbursement for services provided
Completing Medicare, Medicaid and Commercial insurance claim submission.
Documenting and reporting payment information.
Professional level skills in computer use, including but not limited to Microsoft Office, email, web-based applications, and keyboard skills.
Demonstrated strong written and verbal communication skills with providers, patients and insurance companies.
Interpersonal skills to facilitate work with a wide range of individuals and groups from culturally diverse publics.
Problem solving skills.

Nice To Haves

College degree is preferred or high school diploma; equivalent combination of education and experience is also considered.

Responsibilities

Patient Account Management
Research and update patient records with:
Full demographics
Financial and insurance information
Provider and facility details
Prescription data
Patient and provider signatures (as required)
Ensure all documentation is accurate and up to date in Salesforce.
Summary of Benefits (SOB) Review
Confirm eligibility and benefits by reviewing the Benefit Investigation Report (BIR) and the SOB and determine:
Whether a manual BI was completed
If the SOB was generated using the correct template
Revise and finalize the SOB documentation.
Fax the completed SOB to the Health Care Provider’s (HCP) office and follow up, as needed.
Notate the account and complete associated tasks in Salesforce.
Call Handling (Inbound/Outbound)
Verify HIPAA before proceeding (Name, DOB, ZIP, APA number).
Provide one-call resolution whenever possible
Answer inquiries
Address concerns
Research and update account information
Give accurate status updates
Leave voicemails for HCPs/Points of Contact when unable to reach directly.
FRM Collaboration
Communicate via phone, email, or scheduled Microsoft Teams meetings.
Work with Field Reimbursement Managers to align on provider-specific needs or issues.
Provide timely updates or assistance based on FRM feedback or directives.
Administrative Tasks
Perform daily reviews of:
Salesforce tasks (past due and open)
Email inbox
Microsoft Teams messages
Calendar for meetings or deadlines
ACE-specific or territory-specific shared spreadsheets (SharePoint)
Conduct monthly PAP audits to verify accumulations and insurance coverage accuracy, when applicable
Financial Assistance (FA) Support
Review Enrollment Form (EF) for service selections.
Initiate or advance FA case stages appropriately.
Collect and process all required documentation.
Engage in PAP/Copay chat channels to coordinate with subject matter experts.
Submit documentation to the pharmacy via file drop.
Fax or upload FA approval or denial letters to the HCP.
Coordinate with the FRM for any provider-specific FA expectations or guidelines.

Benefits

Supportive, progressive, fast-paced environment
Competitive pay structure
Matching 401(k) with immediate vesting
Medical, dental, vision, life, & short-term disability insurance
Preloaded PTO: 100 hours (12.5 days) PTO upon employment, increasing to 140 hours (17.5 days) upon anniversary. Tenure vacation bonus: $1,000 upon 3-year anniversary and $2,500 upon 5-year anniversary.
Impactful Work: Join a team that is at the forefront of revolutionizing healthcare by improving patient access to essential medications.
Flexible Culture: Many associates earn the opportunity to work from home after 120 days. Enjoy a flexible and inclusive work culture that values work-life balance and diverse perspectives.
Career Growth: We prioritize a “promote from within mentality”. We invest in our employees' growth and development via our Advance Gold program, offering opportunities to expand skill sets and advance within the organization.
Innovation: Contribute to the development of groundbreaking solutions that address complex challenges in the healthcare industry.
Collaborative Environment: Work alongside talented professionals who are dedicated to collaboration, learning, and pushing the boundaries of what's possible. Tell your friends about us! If hired, receive a $750 referral bonus!
#TransformingLives Honor: This quarterly award program is a peer to peer honor that recognizes and highlights some of the amazing ways that our team members are transforming lives for patients on a daily basis.
Values Award: This quarterly award program recognizes individuals who exhibit one, or many, of our core company values; Excellence, Winning, Respect, Inspiration, and Teamwork.
Vision Award: This annual award program recognizes an individual who has gone above and beyond to support the AssistRx vision to transform lives through access to therapy.