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 Oncology business to support enrollment processing for our Rare Hematology and Oncology 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
• Support Specialty Pharmacy referral process
• Support management of Case Management shared email inbox

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

Technical Skills

• Proficiency in Microsoft Office Suite, particularly Excel and Word
• Familiarity with CRM systems and operational platforms
• Strong attention to detail and data entry accuracy
• Basic understanding of operational workflows and procedures

Core Competencies

• Excellent organizational and time management skills
• Strong communication and interpersonal abilities
• Ability to follow detailed instructions and procedures
• Commitment to accuracy and quality in operational execution
• Adaptability to changing operational requirements

Core Competencies & Skills

• Attention to Detail: Ensures accuracy in all operational tasks and documentation
• Organizational Skills: Effectively manages multiple tasks and priorities
• Communication: Clearly conveys information both verbally and in writing
• Teamwork: Collaborates effectively with cross-functional teams
• Adaptability: Adjusts to changing operational needs and processes
• Problem-Solving: Identifies and reports operational issues effectively
• Time Management: Efficiently manages workload and meets deadlines
• Compliance Orientation: Adheres to regulatory and company policies

Success Metrics

• Consistent adherence to standard operating procedures
• Accuracy and timeliness of operational task completion
• Quality of documentation and record-keeping
• Effective utilization of operational systems and tools
• Contribution to team operational goals and objectives
• Compliance with quality and regulatory standards
• Positive feedback from cross-functional team members

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

Travel Requirements

• Minimal travel expected, primarily for occasional team meetings or training sessions

Reporting Structure

• Reports to: Senior Director Operations and Case Management