Sr. Reimbursement Specialist

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 processes to result in starting the patient on client product and ensure the highest level of reimbursement is attained for client product. Extensive knowledge in benefit investigations, data management, and customer service and knowledge of the specialty pharmaceutical process is necessary.

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 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.

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 of Annual PTO Accrual

• Paid Holidays

• 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.

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