Sr. Reimbursement Specialist
Core
Support patients, healthcare providers, payers, and pharmacies throughout the reimbursement and therapy initiation process by coordinating insurance verification, prior authorizations, and coverage requirements.
Role type
Senior Reimbursement Specialist
Builds
Patient access to prescribed pharmaceutical products and therapies
Domain
Healthcare / Pharmaceutical / Insurance
Deliverable
client delivery
Required skills
Insurance verification, prior authorization management, case file management, stakeholder coordination, REMS event reporting, adverse event recognition, customer service, Microsoft Office proficiency, database management
Preferred skills
Health insurance claims experience, patient accounting, third-party billing knowledge, appeals process familiarity, medical terminology knowledge, coding knowledge
Responsibilities
Conduct benefit investigations and verify insurance coverage; Submit prior authorization requests and manage recertifications; Maintain accurate patient and case information in databases; Coordinate product orders, shipments, and therapy initiation; Respond to inquiries from patients, payers, and providers; Identify and report adverse events and product quality complaints; Educate patients and prescribers on program requirements.
Seniority
Senior, hands-on IC
