Senior Reimbursement Specialist - Specialty Pharmacy

This role works directly with healthcare and pharmaceutical providers, as well as insurance plans/payers to gather information about a patient’s insurance and the coverage provided for a specific pharmaceutical product. You will support the healthcare providers addressing questions regarding coding and billing and navigating complex reimbursement issues.

Key Responsibilities:

Patient Account Management

Research and update patient records with:

• Full demographics
• Financial and insurance information
• Provider and facility details
• Prescription data
• Patient and provider signatures (as required)
• Ensure all documentation is accurate and up to date in Salesforce.

Summary of Benefits (SOB) Review

Confirm eligibility and benefits by reviewing the Benefit Investigation Report (BIR) and the SOB and determine:

• Whether a manual BI was completed
• If the SOB was generated using the correct template
• Revise and finalize the SOB documentation.
• Fax the completed SOB to the Health Care Provider’s (HCP) office and follow up, as needed.
• Notate the account and complete associated tasks in Salesforce.

Call Handling (Inbound/Outbound)

• Verify HIPAA before proceeding (Name, DOB, ZIP, APA number).
• Provide one-call resolution whenever possible
• Answer inquiries
• Address concerns
• Research and update account information
• Give accurate status updates
• Leave voicemails for HCPs/Points of Contact when unable to reach directly.

FRM Collaboration

• Communicate via phone, email, or scheduled Microsoft Teams meetings.
• Work with Field Reimbursement Managers to align on provider-specific needs or issues.
• Provide timely updates or assistance based on FRM feedback or directives.

Administrative Tasks

Perform daily reviews of:

• Salesforce tasks (past due and open)
• Email inbox
• Microsoft Teams messages
• Calendar for meetings or deadlines
• ACE-specific or territory-specific shared spreadsheets (SharePoint)
• Conduct monthly PAP audits to verify accumulations and insurance coverage accuracy, when applicable

Financial Assistance (FA) Support

• Review Enrollment Form (EF) for service selections.
• Initiate or advance FA case stages appropriately.
• Collect and process all required documentation.
• Engage in PAP/Copay chat channels to coordinate with subject matter experts.
• Submit documentation to the pharmacy via file drop.
• Fax or upload FA approval or denial letters to the HCP.
• Coordinate with the FRM for any provider-specific FA expectations or guidelines.

Required Skills & Qualifications:

• Strong knowledge of benefit verification and financial assistance programs.
• Experience with Salesforce or equivalent CRM tools.
• High attention to detail and task completion accuracy.
• Effective communication via phone, email, and collaboration tools (Teams).
• Ability to manage high-volume caseloads with time-sensitive responsibilities.
• Familiarity with HIPAA regulations and patient confidentiality standards.

• QUALIFICATIONS:
• College degree is preferred or high school diploma; equivalent combination of education and experience is also considered.
• Other skills required: 
• Previous work experience in Medical and Pharmacy Reimbursement or Customer Service.
• Submitting billing data to appropriate insurance providers
• Processing claims and resolving denial instances.
• Achieving maximum reimbursement for services provided
• Completing Medicare, Medicaid and Commercial insurance claim submission.
• Documenting and reporting payment information.
• Professional level skills in computer use, including but not limited to Microsoft Office, email, web-based applications, and keyboard skills.
• Demonstrated strong written and verbal communication skills with providers, patients and insurance companies.
• Interpersonal skills to facilitate work with a wide range of individuals and groups from culturally diverse publics.
• Problem solving skills.

COMPETENCIES:

Attendance/Punctuality - Is consistently at work and on time; Ensures work responsibilities are covered when absent; Arrives at meetings and appointments on time.

Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.

Dependability - Follows instructions, responds to management direction; Takes responsibility for own actions; Keeps commitments; Commits to long hours of work when necessary to reach goals; Completes tasks on time or notifies appropriate person with an alternate plan.

Professionalism - Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.

Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality.

Teamwork - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed.

Diversity - Demonstrates knowledge of EEO policy; Shows respect and sensitivity for cultural differences; Educates others on the value of diversity; Promotes a harassment-free environment; Builds a diverse workforce.

Ethics - Treats people with respect; Keeps commitments; Inspires the trust of others; Works with integrity and ethically; Upholds organizational values.

• Supportive, progressive, fast-paced environment
• Competitive pay structure
• Matching 401(k) with immediate vesting
• Medical, dental, vision, life, & short-term disability insurance

Why Choose AssistRx:

• Preloaded PTO: 100 hours (12.5 days) PTO upon employment, increasing to 140 hours (17.5 days) upon anniversary. Tenure vacation bonus: $1,000 upon 3-year anniversary and $2,500 upon 5-year anniversary.
• Impactful Work: Join a team that is at the forefront of revolutionizing healthcare by improving patient access to essential medications.
• Flexible Culture: Many associates earn the opportunity to work from home after 120 days. Enjoy a flexible and inclusive work culture that values work-life balance and diverse perspectives.
• Career Growth: We prioritize a “promote from within mentality”. We invest in our employees' growth and development via our Advance Gold program, offering opportunities to expand skill sets and advance within the organization.
• Innovation: Contribute to the development of groundbreaking solutions that address complex challenges in the healthcare industry.
• Collaborative Environment: Work alongside talented professionals who are dedicated to collaboration, learning, and pushing the boundaries of what's possible. Tell your friends about us! If hired, receive a $750 referral bonus!

Wondering how we recognize our employees for delivering best in class results? Here are some of the awards that our employees receive throughout the year!

• #TransformingLives Honor: This quarterly award program is a peer to peer honor that recognizes and highlights some of the amazing ways that our team members are transforming lives for patients on a daily basis.
• Values Award: This quarterly award program recognizes individuals who exhibit one, or many, of our core company values; Excellence, Winning, Respect, Inspiration, and Teamwork.
• Vision Award: This annual award program recognizes an individual who has gone above and beyond to support the AssistRx vision to transform lives through access to therapy.

AssistRx, Inc. is proud to be an Equal Opportunity Employer. All qualified applicants will receive consideration without regard to race, religion, color, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, family medical history or genetic information, political affiliation, military service, or other non-merit based factors, or any other protected categories protected by federal, state, or local laws.

All offers of employment with AssistRx are conditional based on the successful completion of a pre-employment background check.

In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire. Sponsorship and/or work authorization is not available for this position.

AssistRx does not accept unsolicited resumes from search firms or any other vendor services. Any unsolicited resumes will be considered property of AssistRx and no fee will be paid in the event of a hire.