Senior Reimbursement Specialist - Specialty Pharmacy

This role works directly with healthcare and pharmaceutical providers, as well as insurance plans and payers, to gather information about a patient’s insurance and coverage for specific pharmaceutical products. You will support healthcare providers by addressing questions on coding, billing, and navigating complex reimbursement issues. Daily tasks focus on ensuring accurate patient data and benefit documentation.

Manage patient accounts by researching and updating records in Salesforce with full demographics, financial and insurance information, provider details, prescription data, and required signatures. Review Summary of Benefits (SOB) by confirming eligibility via Benefit Investigation Reports, revising documentation, faxing to HCP offices, and notating accounts. Handle inbound and outbound calls with HIPAA verification for one-call resolutions and status updates.

Collaborate with Field Reimbursement Managers through phone, email, or Microsoft Teams to align on provider-specific needs and provide timely assistance. Perform administrative tasks including daily reviews of Salesforce tasks, email inbox, Teams messages, calendars, and shared spreadsheets. Conduct monthly PAP audits to verify accumulations and insurance coverage accuracy.

Support Financial Assistance by reviewing Enrollment Forms, initiating case stages, collecting documentation, engaging chat channels with experts, and submitting to pharmacies. Fax or upload approval/denial letters to HCPs and coordinate with FRMs on provider expectations. Thrive in a high-volume environment managing time-sensitive caseloads with attention to HIPAA compliance.