Reimbursement Resource Specialist

Reimbursement Resource Specialist

Position Title: Reimbursement Resource Specialist

Department: Patient Support Services PSS Case Management

Job Family: PSS Operations

Location: Remote

Employment Type: Contract Employee

Duration: 6 Months

Role Summary: 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 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 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 Rare Blood Disorders and FDA rules and regulations
• Support Specialty Pharmacy referral process
• Support management of Case Management shared email inbox

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

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

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