Benefits Verification Specialist

UBC; Oregon; Hybrid; USD 60,000 - 80,000; Full time

Benefits offered by this job

Remote opportunities

Competitive salaries

Growth opportunities for promotion

401K with company match

Tuition reimbursement

Flexible work environment

20 days PTO

Paid Holidays

Employee assistance programs

Medical, Dental, and vision coverage

HSA/FSA

Telemedicine (Virtual doctor)</nhaids)

Job summary

UBC is seeking a Sr. Reimbursement Specialist (Benefits Verification Specialist) to deliver high-quality customer service for patients, families, payers, home cares, and physicians.

The role focuses on expediting patient initiation, maximizing client product reimbursement, and coordinating with pharmacy and care teams. The ideal candidate has 4–6 years of experience in insurance/pharma, strong communication skills, and solid knowledge of prior authorizations and appeals.

Qualifications

• High School Diploma or GED.
• 4–6 years’ experience in insurance, biotech, or pharmaceutical industries; customer service and/or reimbursement.
• Health Insurance claims or patient accounting experience is a plus.
• Proficient with MS Office and database systems.
• Excellent written and verbal communication skills across all levels.
• Ability to manage multiple priorities and meet deadlines.
• Detail oriented with strong analytical skills.
• Knowledge of third party billing, coding, medical terminology, prior authorizations and appeals preferred.

Responsibilities

• Conduct benefit investigations and verify insurance benefits for patients and physicians’ offices.
• Submit and obtain prior authorizations as required by payer; recertification for extended coverage.
• Enter and maintain data in client databases; monitor status of client case files.
• Participate in conference calls with client sales reps, management and physicians’ offices.
• Coordinate orders for product, shipment, and therapy initiation with pharmacy and patient.
• Triage calls from patients, insurers, physicians, sales reps, and home care agencies; may serve as single point of contact for prescribers.
• Identify and report REMS-related events and adverse events to the appropriate team.
• Educate patients and prescribers on program requirements and facilitate referrals.
• Maintain good housekeeping and comply with safety, quality, and environmental programs.

Skills

Insurance experience

Reimbursement processes

Customer service

MS Office

Communication

Prior authorizations

Data entry

Attention to detail

Education

High School Diploma/GED

Tools

MS Office

Job description

As a pharmaceutical support industry leader, UBC is devoted to empowering health solutions for a better tomorrow. We take pride in improving patient outcomes and advancing healthcare. At UBC we 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 impact on 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 (Benefits Verification Specialist)

Brief Summary: The primary goal of this position is to provide high quality customer service, effectively interface with patients, patients' 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.

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 opportunitiesCompetitive salariesGrowth opportunities for promotion401K with company match*Tuition reimbursementFlexible work environment20 days PTOPaid HolidaysEmployee assistance programsMedical, Dental, and vision coverageHSA/FSATelemedicine (Virtual doctor appointments)Wellness programAdoption assistanceShort term disabilityLong term disabilityLife insuranceDiscount 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.