Reimbursement Resource Specialist

Title: Reimbursement Resource Specialist
Duration: 6 Months+ Possible Extension
Location: Cambridge, MA- Remote
Pay Range: $36-$38/hr


Must have Skills:

• Min Bachelor's Degree or higher
• Minimum 4-5 years' experience in health insurance reimbursement, medical billing, or equivalent applicable work experience
• Strong Pharma reimbursement experience or health care industry reimbursement experience
• Experience in high volume setting
• Strong MS Office/ 365
• Nice to Have/ Preferred skills: Experience with Salesforce CRM preferred

Notes:
Fully Remote
However initial travel and onsite training will be required for initial 1-2 weeks
2 Shifts
#1:Work hours: 9:00 AM - 5:00 PM (EST)
#2: Work hours: 11:00 AM - 7:00 PM (EST)

Description:
The Reimbursement Support Specialist will support and work collaboratively with Case Managers in the Rare Blood Disorders and Onc business to support enrollment processing for our Rare Hematology and Onc portfolio, assist with the facilitation of the reimbursement process for our Rare Hematology product portfolio, which includes assisting with benefit investigations and being the first in line for inbound calls. This role is an essential part of the case management process that requires a high level of organization and strong communication skills. The Reimbursement Support Specialist follows standardized workflows as defined by management. This is a skilled position that requires customer service and/or healthcare insurance reimbursement experience.

Key Responsibilities
Assist with the verification of insurance coverage policies and benefit details through direct contact with medical insurance providers with prompt communication of accurate information to facilitate the initiation and ongoing continuation of treatment
Research and identify insurance company prior authorization processes and provide necessary documents and requirements to Case Management team members
Re-verify insurance benefits and coverage as needed to assist the Case Management Team with prompt service for Patients and Facilities
Assist case management team in the resolution of co-pay claim issues related to Client Co-Pay Assistance Program
Maintain up-to-date knowledge of the reimbursement process, healthcare policy, insurance plans, payer trends, financial assistance programs, and related resources
Complete daily documentation of all interactions and input accurate data, which includes inbound phone calls, prescription information, insurance and PBM information, coverage approvals and/or denials, prior authorization information and ongoing coverage requirements in iCare Database while maintaining compliance with HIPAA and other applicable healthcare and privacy regulations
Establish proficiency and full understanding of the Client Rare Blood Disorders and Onc Patient Support Services Customer Relationship database including understanding of data elements, case statuses and outcomes, and documentation requirements
Receive and report all Adverse Events and Product Technical Complaints to Pharmacovigilance in accordance with Client, Rare Blood Disorders and FDA rules and regulations


Requirements & Qualifications
Required Qualifications
Bachelor's degree required
4-5 years' experience in health insurance reimbursement, medical billing, or equivalent applicable work experience
Effective communication, problem-solving and negotiation skills required
Ability to think critically and problem solve to address customer needs
Ability to work collaboratively and independently in a fast-paced environment
Proficient with Microsoft Office, Word, Excel, and PowerPoint
Ability to travel for required on-site for training for initial 1-2 weeks
Preferred Qualifications
Experience working in a high-volume patient services program preferred
Experience with Salesforce CRM preferred
Travel Requirements
Minimal travel expected, primarily for occasional team meetings or training sessions

Reporting Structure
Reports to: Senior Director Operations and Case Management