Experienced Reimbursement Specialist (Healthcare CSR) – Insurance Benefit Verification and Reimbursement Coordination

About the Role We are seeking an experienced Reimbursement Specialist to join our team in a remote setting. As a Reimbursement Specialist, you will play a crucial role in ensuring that healthcare providers receive accurate and timely reimbursement for their services. Your primary responsibility will be to verify patient insurance benefits, confirm coverage, and ensure that all necessary prior authorizations are in place. This role requires strong communication and problem-solving skills, as well as the ability to work independently in a fast-paced environment. About the Company Our company is a leading provider of healthcare services, and we are committed to delivering exceptional patient care and support. We are a dynamic and growing organization that values innovation, teamwork, and customer satisfaction. As a Reimbursement Specialist, you will be part of a talented team that is dedicated to making a positive impact in the lives of our patients and healthcare providers. Key Responsibilities As a Reimbursement Specialist, your key responsibilities will include: Verifying patient insurance benefits and confirming coverage Ensuring that all necessary prior authorizations are in place and valid Collecting and reviewing patient insurance benefit information according to program SOPs Completing and submitting insurance forms and prior authorizations in a timely manner Providing exceptional customer service to internal and external customers Maintaining regular phone contact with provider representatives, third-party customer service reps, and pharmacy staff Effectively communicating with payors for benefit investigations and coordinating with inter-departmental associates as necessary Processing insurance and patient correspondence Reporting reimbursement trends or delays to the supervisor Providing all necessary documentation for prior authorizations, including demographic details and relevant identification numbers Analyzing moderate scope problems within defined SOPs and exercising judgment to determine appropriate actions Reporting all adverse events in line with training and SOP Requirements To be successful as a Reimbursement Specialist, you will need to possess the following qualifications and skills: 1 year of experience in specialty pharmacy, medical insurance, healthcare setting, and/or related experience Patient: Hold times may be up to 90 minutes by client requirements Private, designated workspace MS Office proficiency: Excel, Outlook, Word Flexibility on schedule and hours Personal cellphone for MFA Employment verification required: Last 3 employers High school diploma or equivalent Background check required Preferred Qualifications While not required, the following qualifications and skills are preferred: 2 years of experience in prior authorizations, co-pay, deductibles, health insurance, and medical terminology Experience working in a healthcare setting, preferably in a specialty pharmacy or medical insurance environment Strong communication and problem-solving skills Ability to work independently in a fast-paced environment Experience with CRM software and prior authorization systems Training and Development As a Reimbursement Specialist, you will receive comprehensive training and support to ensure your success in this role. This will include: Approximately 3 weeks of training, consisting of practice and mock calls Variety of assessments during training to ensure program score requirements are met Hands-on learning of the CRM, specific client program protocol requirements, and script navigation Work Environment and Culture As a remote Reimbursement Specialist, you will work from the comfort of your own home, with the flexibility to create your own schedule and work environment. Our company values a positive and supportive work culture, and we strive to create an environment that is inclusive, diverse, and respectful. Compensation and Benefits As a Reimbursement Specialist, you will be compensated at a competitive rate of $17.00-$19.00 per hour, depending on your level of experience. You will also be eligible for a range of benefits, including: Comprehensive training and support Opportunities for career growth and advancement Flexible scheduling and work environment Competitive compensation and benefits package How to Apply If you are a motivated and detail-oriented individual with a passion for healthcare and customer service, we encourage you to apply for this exciting opportunity. Please submit your application today, and join our team of dedicated professionals who are making a positive impact in the lives of our patients and healthcare providers. Apply for this job