Reimbursement Resource Specialist

Aequor Technologies LLC

Cambridge, MA(remote)

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JOB DETAILS

SKILLS

Adverse Events, Blood Disorders, Business Support, Case Management, Co-Payments, Communication Skills, Cross-Functional, Customer Relations, Customer Relationship Management (CRM), Customer Relationship Management (CRM) Systems, Customer Support/Service, Data Entry, Detail Oriented, Documentation, FDA Requirements, Financial Trend Analysis, HIPAA (Health Insurance Portability and Accountability Act), Health Insurance, Healthcare, Healthcare Providers, Healthcare Reimbursement, Hematology, Insurance, Interpersonal Skills, Maintain Compliance, Medical Billing, Metrics, Microsoft Excel, Microsoft Office, Microsoft PowerPoint, Microsoft Word, Multitasking, Negotiation Skills, Onboarding, Operations Management, Operations Processes, Organizational Skills, Patient Care, Pharmacovigilance, Pharmacy, Privacy Regulations, Problem Solving Skills, Regulations, Regulatory Compliance, Reimbursement, Resolve Customer Issues, Salesforce.com, Standard Operating Procedures (SOP), Standards Development, System Operations, Team Player, Time Management, Willing to Travel

LOCATION

Cambridge, MA

POSTED

1 day ago

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

About the Company

Aequor Technologies LLC

COMPANY SIZE

100 to 499 employees

INDUSTRY

Staffing/Employment Agencies

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