Sr. Patient Reimbursement Associate

McKesson•Cary, NC

15d•$15 - $25

About The Position

The Sr. Patient Reimbursement Associate at Biologics, Inc. plays a critical role in supporting patients and healthcare providers navigate the complexities of insurance coverage and financial assistance for Biologics' products. This position ensures timely access to essential therapies by providing expert guidance on reimbursement processes and resolving coverage issues.

Requirements

Bachelor's degree in a healthcare-related field, business administration, or equivalent experience required.
Minimum of 3-5 years of experience in patient reimbursement, benefits investigation, prior authorization, or a similar role within the pharmaceutical, biotech, or healthcare industry.
Demonstrated expertise in navigating commercial insurance, Medicare, Medicaid, and other government payer programs.
Strong understanding of medical terminology, billing codes (CPT, ICD-10, HCPCS), and reimbursement methodologies.
Excellent communication, interpersonal, and problem-solving skills with a patient-centric approach.
Ability to manage a high volume of cases, prioritize tasks effectively, and work independently in a fast-paced environment.
Proficiency in CRM software (e.g., Salesforce) and Microsoft Office Suite (Word, Excel, Outlook).
Proven ability to work collaboratively within a team and cross-functionally.
High degree of accuracy and attention to detail in all aspects of work.
Familiarity with HIPAA and other relevant healthcare compliance regulations.

Responsibilities

Serve as a primary point of contact for patients and healthcare providers regarding insurance benefits, coverage criteria, and appeals processes for Biologics' products.
Conduct thorough benefits investigations to determine patient eligibility and out-of-pocket costs, utilizing various payer resources and communication channels.
Assist patients and providers in completing and submitting prior authorization requests, appeals, and other necessary documentation to secure coverage.
Proactively identify and resolve complex reimbursement challenges, including denied claims, step therapy requirements, and limited distribution issues.
Educate patients and healthcare professionals on available financial assistance programs, co-pay foundations, and patient access services.
Maintain accurate and detailed records of all patient interactions, reimbursement activities, and case statuses within the designated CRM system.
Collaborate closely with internal sales, marketing, and medical affairs teams to address patient access barriers and improve overall support.
Stay up-to-date on evolving payer policies, industry regulations, and reimbursement trends affecting Biologics' product portfolio.
Participate in training and development initiatives to enhance knowledge of Biologics' products, disease states, and reimbursement landscape.
Adhere to all HIPAA regulations, compliance guidelines, and company policies regarding patient data and privacy.