Sr. Reimbursement Specialist

As a pharmaceutical support industry leader, UBC is devoted to empowering health solutions for a better tomorrow. We take pride in improvingpatient outcomes and advancing healthcare.At UBCwe provide services to enhance the entire drug development process and commercialization lifecycle - From clinical trial support to real-world evidence generation.

Embark on a rewarding career journey with UBC!Grow your career while making a meaningful impacton the world around you. UBC fosters a culture built on our Core Values of Respect, Accountability, Innovation, Quality, Integrity, and Collaboration. We believe in an inclusive workplace that fosters creativity.

If you are seeking a career that will challenge, inspire, and reward you, join us at UBC!

Sr. Reimbursement Specialist

Shifts: This position supports business operations between 8:00 AM and 9:00 PM Eastern Time. Candidates must be available to work a full-time assigned shift within these hours. Examples of potential schedules include:

• 8:00 AM – 5:00 PM ET
• 9:00 AM – 6:00 PM ET
• 10:00 AM – 7:00 PM ET
• 11:00 AM – 8:00 PM ET
• 12:00 PM – 9:00 PM ET

Assigned schedules are determined based on business and client needs.Candidates residing outside of the Eastern Time Zone are welcome to apply but must be able to work their assigned shift based on Eastern Time business hours.

Brief Summary:

The primary goal of this position is to provide high quality customer service, effectively interface with patients, patient’s families, national payers, home cares and medical doctor’s offices to assist patient and medical provider in expediting the process starting the patient on client product, and ensure the highest level of reimbursement is attained for client product. Extensive knowledge in specialized functions with a wide and comprehensive acquaintance with and understanding of both general and specific aspects of the job and their practical application to complex problems and situations ordinarily encountered.

Specific job duties:

• Conduct benefit investigations, verify insurance benefits for patient and physicians’ offices, and submit and obtain prior authorizations as required by payer; obtain recertification for cases requiring extended treatment/coverage beyond the expiration of original approval.
• Accurately enter and maintain data as required in client database and patient files and utilize the client database to monitor outstanding items on each client case file. Ensure files are complete so team can determine the current status.
• Participate in conference calls as needed with Client Sales Representatives, client management and physicians’ offices regarding status of cases, drug orders and status of alternative funding.
• Provide coordination of order for product, shipment of product, and therapy initiation with pharmacy and patient.
• Participate in Call Center Activities, triage and respond to incoming calls from patients, insurance companies, physicians, Sales Reps, pharmacies and homecare agencies. May serve as single point of contact for an assigned group of prescribers.
• Identify and report events as required by the REMS requirements for specified medication. Recognize adverse event, product quality complaint, potential risk events, and forward information to the appropriate team member for reporting to the manufacturer.
• Educate patients, prescribers, and others regarding program requirements, and facilitate referrals. Maintain good housekeeping techniques, adhering to quality and production standards and comply with all applicable company, state, and federal safety and environmental programs and procedures.

Desired Skills and Qualifications:

• High School Diploma/GED or equivalent experience
• 4 – 6 years’ experience in the insurance, biotechnology, or pharmaceutical industries; customer service and/or reimbursement. Health Insurance claims or patient accounting experience a plus.
• Computer proficiency in MS Office applications, with database experience a plus.
• Excellent written and verbal communication skills, with demonstrated ability to communicate with others at all levels.
• Ability to manage multiple priorities and meet deadlines.
• Detail oriented with good analytical skills.
• Knowledge of third party billing, coding, medical terminology, prior authorizations and appeals preferred.
• Ability to travel as required - This is primarily a remote position; however, occasional travel may be required based on client, business, or training needs. While travel is expected to be infrequent, candidates must be willing and able to travel as needed. Travel requirements may vary depending on the client program and business objectives.

Benefits:

At UBC, employee growth and well-being are always at the forefront. We offer an extensive range of benefits to ensure that you have everything you need to thrive personally and professionally.

Here are some of the exciting perks UBC offers:

• Remote opportunities
• Competitive salaries
• Growth opportunities for promotion
• 401K with company match*
• Tuition reimbursement
• Flexible work environment
• 20 days PTO
• Employee assistance programs
• Medical, Dental, and vision coverage
• HSA/FSA
• Telemedicine (Virtual doctor appointments)
• Wellness program
• Adoption assistance
• Short term disability
• Long term disability
• Life insurance
• Discount programs

UBC is proud to be an equal opportunity employer and does not discriminate because of race, color, sex, age, national origin, religion, sexual orientation, gender identity and/or expression, status as a veteran, and basis of disability or any other federal, state, or local protected class. We are committed to a diverse, equitable and inclusive culture that fosters respect for each other, our clients, and our patients.

Originally posted on Himalayas