Senior Benefits & Reimbursement Specialist

We are seeking a Senior Benefits & Reimbursement Specialist to support timely patient access to care by managing an assigned caseload of benefits investigations, prior authorizations, and appeals for a growing healthcare organization. This position is a full time, hybrid opportunity with work from home flexibility following initial training. This role serves as the primary point of contact for assigned patients and provider offices, partnering with insurance carriers and internal teams to resolve coverage issues and keep care on track.

This position is well aligned for a reimbursement professional with experience managing an independent caseload and navigating complex coverage requirements. The successful candidate will bring a strong understanding of medical and pharmacy benefits, sound judgment, and a consistent focus on accuracy and follow through.

Responsibilities:

• Own an assigned caseload of patients and provider offices from referral through final coverage resolution
• Lead benefits investigations across medical and pharmacy benefits and determine the best coverage path for each case
• Prepare, submit, and manage prior authorizations through to a decision
• Analyze denials, build appeals with supporting documentation, and pursue them through each level of review
• Serve as the primary contact for payers on assigned cases, confirming plan requirements, coverage details, and authorization status
• Identify coverage risks early and resolve barriers such as delays, denials, and plan restrictions before they affect patient care
• Connect eligible patients with financial assistance resources
• Keep provider offices and internal teams informed with timely, accurate case updates
• Document all patient and payer interactions accurately and in line with HIPAA requirements
• Handle complex and escalated cases using sound judgment and established protocols
• Prioritize a full caseload independently while meeting service level and turnaround goals

Qualifications:

• High school diploma or equivalent
• Healthcare certification such as CPhT, CPC, or CRCR is a plus
• 2+ years of direct reimbursement experience managing an assigned caseload, including benefits investigation, prior authorization, appeals, and payer communication
• Background in a healthcare, insurance, or patient services setting
• Strong working knowledge of medical and pharmacy benefit structures and coverage determinations
• Preferred: experience with commercial, Medicare, Medicaid, and government plans
• Preferred: experience in a patient support role with ownership of provider relationships
• Strong written and verbal communication with close attention to detail
• Proven ability to manage priorities independently and meet service level goals

Schedule:

• Full time, 40 hours per week, Monday through Friday
• Hybrid: on site during initial paid training, with work from home flexibility beyond training
• Shifts are scheduled between 8:00 AM and 8:00 PM EST
• Equipment provided; reliable home internet required
• Candidates must reside within commuting distance of the Greater Pittsburgh area

Salary Range:

The salary range for this position is approximately $45,760 to $62,400 annually ($22 to $30 per hour), based on experience and qualifications.

Interview Process:

Selected candidates will begin with an initial screening with TalentLNX, followed by a final interview with the patient services leadership team.

Equal Opportunity Employer:

TalentLNX is committed to equal employment opportunity and a diverse, inclusive workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, pregnancy, sexual orientation, gender identity, national origin, age, disability, genetic information, veteran status, or any other characteristic protected by applicable federal, state, or local law.