Sr. Reimbursement Specialist

Jobgether

3d • Remote

About The Position

This role is designed for an experienced reimbursement professional who thrives at the intersection of patient support, insurance navigation, and healthcare operations. You will play a critical role in ensuring patients gain timely access to prescribed therapies by managing benefit investigations, prior authorizations, and reimbursement processes. Acting as a key liaison between patients, providers, payers, and pharmacies, you will help streamline therapy initiation while maximizing coverage outcomes. This position requires deep knowledge of insurance protocols, strong communication skills, and the ability to manage complex cases with precision. Working in a collaborative, quality-driven environment, you will directly contribute to improving patient experiences and healthcare outcomes nationwide.

Requirements

• High School Diploma/GED required; additional education or equivalent experience preferred.
• 4–6 years of experience in insurance, biotechnology, pharmaceutical industries, reimbursement support, or healthcare customer service.
• Experience with health insurance claims, patient accounting, third-party billing, coding, medical terminology, prior authorizations, and appeals preferred.
• Proficiency in Microsoft Office applications; database experience is a plus.
• Strong written and verbal communication skills with the ability to interact effectively at all organizational levels.
• Detail-oriented with solid analytical and problem-solving abilities.
• Ability to manage multiple priorities, meet deadlines, and handle complex case scenarios.
• Demonstrated professionalism, empathy, and commitment to delivering high-quality patient support.

Responsibilities

• Conduct benefit investigations, verify insurance coverage, and manage prior authorizations and recertifications to ensure uninterrupted patient access to therapy.
• Accurately enter, maintain, and monitor case data within internal systems to track outstanding items and ensure case completeness.
• Coordinate product orders, shipment logistics, and therapy initiation in collaboration with pharmacies, providers, and patients.
• Serve as a key point of contact for patients, prescribers, payers, sales representatives, and homecare agencies, managing inbound inquiries and case escalations.
• Participate in case review calls with internal and external stakeholders to provide status updates and reimbursement insights.
• Identify and appropriately report adverse events, product quality complaints, and REMS-related requirements in compliance with regulatory standards.
• Educate patients and providers on program requirements, reimbursement pathways, and alternative funding options.
• Maintain adherence to quality standards, compliance protocols, and applicable healthcare regulations.

Benefits

• Remote work opportunities and flexible work environment.
• Competitive salary and opportunities for career growth and promotion.
• 401(k) plan with company match.
• Tuition reimbursement programs.
• 20 days of paid time off plus paid holidays.
• Comprehensive medical, dental, and vision coverage.
• HSA/FSA options and telemedicine services.
• Wellness programs and employee assistance programs.
• Adoption assistance, short-term and long-term disability coverage, and life insurance.
• Access to employee discount programs.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED