Reimbursement Resource Specialist
Aequor JD ·www.aequor.com
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Fully remote
Initial onsite 1 week training will be required within 2-3 months after onboarding
Must be willing to travel and reimbursement will be offered
Work hours: 9:00 AM - 5:00 PM (est)
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
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
Initial onsite 1 week training will be required within 2-3 months after onboarding
Must be willing to travel and reimbursement will be offered
Work hours: 9:00 AM - 5:00 PM (est)
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
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
Frequently asked questions
Who is hiring for the Reimbursement Resource Specialist role?
Aequor JD is hiring for the Reimbursement Resource Specialist position, a Shazamme client. Apply directly on the employer's career site.
Where is the Reimbursement Resource Specialist job located?
The Reimbursement Resource Specialist role with Aequor JD is based in Cambridge, MA, US. The role is remote-friendly.
Is the Reimbursement Resource Specialist role remote?
Yes — the Reimbursement Resource Specialist position at Aequor JD is remote. Candidates based in US are preferred.
What does the Reimbursement Resource Specialist role pay?
Aequor JD lists the Reimbursement Resource Specialist role at USD 30–36 per hour.
Is the Reimbursement Resource Specialist role full-time or contract?
This is a full time position at Aequor JD.
What experience level is the Reimbursement Resource Specialist role?
The Reimbursement Resource Specialist position is aimed at mid-level candidates.
How do I apply for the Reimbursement Resource Specialist role at Aequor JD?
Apply directly on Aequor JD's career page via the Apply button on this listing. ZammeJobs links straight through to the employer's ATS — no third-party form, no resume database.