Sr. Reimbursement Specialist

United Biosource Corporation• Remote, US,

21h•Remote

About The Position

The Sr. Reimbursement Specialist provides high-quality customer service and works with patients, patients’ families, national payers, home care providers, and medical offices to help patients and providers expedite treatment initiation with client products and attain the highest possible level of reimbursement. The role requires extensive knowledge of specialized functions and the ability to apply broad knowledge of job-related practices to complex problems and situations. The specialist conducts benefit investigations and verifies insurance coverage; obtains prior authorizations and recertifications; maintains accurate client database records and patient files; and coordinates product orders, shipments, and therapy initiation with pharmacies and patients. The role also handles and triages incoming calls, communicates case status with clients and providers, and may serve as the single point of contact for assigned prescribers. The position includes educating patients and prescribers about program requirements, facilitating referrals, and identifying and forwarding reportable events under applicable REMS requirements. The specialist is expected to follow quality and production standards and applicable company, state, and federal safety and environmental procedures.

Requirements

High school diploma/GED or equivalent experience.
4–6 years of experience in the insurance, biotechnology, or pharmaceutical industries, in customer service and/or reimbursement.
Computer proficiency with MS Office applications.
Excellent written and verbal communication skills and demonstrated ability to communicate with people at all levels.
Ability to manage multiple priorities and meet deadlines.
Detail orientation and good analytical skills.

Nice To Haves

Health insurance claims or patient accounting experience.
Database experience.
Knowledge of third-party billing, coding, medical terminology, prior authorizations, and appeals.

Responsibilities

Conduct benefit investigations and verify insurance benefits for patients and physicians’ offices.
Submit and obtain payer-required prior authorizations and obtain recertifications when coverage or treatment extends beyond the original approval period.
Accurately enter and maintain information in client databases and patient files, monitor outstanding case items, and ensure files are complete and current.
Participate in conference calls with Client Sales Representatives, client management, and physicians’ offices regarding case status, drug orders, and alternative funding.
Coordinate product orders and shipments and therapy initiation with pharmacies and patients.
Participate in call center activities and triage and respond to incoming calls from patients, insurance companies, physicians, sales representatives, pharmacies, and homecare agencies.
Serve as the single point of contact for an assigned group of prescribers when needed.
Identify and report events as required by REMS requirements for specified medications, including adverse events, product quality complaints, and potential risk events, and forward information to the appropriate team member for manufacturer reporting.
Educate patients, prescribers, and others about program requirements and facilitate referrals.
Maintain good housekeeping practices, adhere to quality and production standards, and comply with applicable company, state, and federal safety and environmental programs and procedures.