Reimbursement Support Specialist

Aequor; Cambridge (MA); On-site; USD 43,000 - 62,000; Part time

Job summary

Aequor is seeking a Reimbursement Support Specialist to join our Rare Blood patient support program in Cambridge, MA. The role collaborates with Case Management to facilitate reimbursement processes for our product portfolio and ensures accurate, timely information flows to providers and payers.

The ideal candidate has 1-3 years of health insurance reimbursement experience, strong communication and problem-solving skills, and familiarity with Salesforce CRM.

Qualifications

• AA degree required; Bachelor's preferred.
• 1-3 years' experience in health insurance reimbursement.
• Salesforce CRM experience preferred.
• Proficient in MS Word, Excel and PowerPoint.
• Ability to handle confidential patient data with discretion.

Responsibilities

• Verify insurance coverage and benefit details with providers.
• Identify prior authorization processes and provide documents.
• Follow up with payers on authorization status.
• Re-verify benefits as needed for patients.
• Address denied or incomplete claims and reduce barriers.
• Track in-process claims and provide updates to teams.
• Assist with copay claim issues for Copay Assistance Program.
• Document interactions in CRM per HIPAA policies.

Skills

Customer service

Communication skills

Problem solving

Negotiation skills

HIPAA/compliance

Education

AA Degree

Bachelor's Degree preferred

Tools

Salesforce CRM

MS Word

MS Excel

MS PowerPoint

Job description

Duration: Contract till May 2027 with possibility to extend

Pay Rate: $38/hr on W2

Job Title: Reimbursement Support Specialist

Reports To: Director, Case Management Rare Blood Disorders

About the Job

***'s Rare Blood patient support program is for people living with rare blood disorders, offering financial assistance, education, and access help throughout their *** prescribed therapy journey. The patient support organization consists of field teams that provide education to patients and health care providers to help patients start and stay on treatment as prescribed

The Reimbursement Support Specialist (RSS) will support and work collaboratively with Case Managers to facilitate the reimbursement process for our product portfolio. 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, medical billing and/or healthcare insurance reimbursement experience. The RSS role is a support services function within a patient program and is not a patient-facing role.

Job Responsibilities:

Verify current insurance coverage policies and benefit details through direct contact with medical insurance providers and ensure prompt return of accurate information to facilitate the initiation and ongoing continuity of treatment

Research and identify insurance company prior authorization processes and provide necessary documents and requirements to Case Management team members

Follow up with payers to determine status of prior authorizations for enrolled patients

Re-verify insurance benefits as needed for the patients

Research denied and incomplete claims to address potential barriers impacting access to continued treatment

Track and follow up on in-process claims and denials to the point of resolution providing ongoing cross functional updates

Assist Patient Support Services team in the resolution of copay claim issues related to *** Copay Assistance Program

Process new enrollment forms

Provide quality phone customer service to inbound callers

Coordinate with the Reimbursement Support Specialist team to efficiently assign and distribute tasks from the shared work queue

Maintain up-to-date knowledge of the reimbursement process, billing/coding guidelines, dose calculations, healthcare policy, insurance plans, payer trends, financial assistance programs, and related resources

Complete daily documentation of all interactions and input accurate data on each individual cases, their insurance, coverage approvals and ongoing coverage requirements in CRM Database while maintaining compliance with HIPAA and other regulating bodies as required

Establish proficiency and full understanding of *** Patient Support Services Customer Relationship database including undertaking of data elements, case statuses and outcomes, and documentation requirements

Ensure full compliance with *** policies, procedures, and guidelines

AA Degree required, Bachelors Degree preferred

1-3 years' experience in health insurance reimbursement or equivalent applicable work experience preferred

Demonstrated ability to handle sensitive and confidential information, including patient personal data (PII/PHI), with discretion and care at all times

Effective communication, problem-solving and negotiation skills

Ability to think critically and problem solve to address customer needs

Ability to work in a fast-paced environment

Experience working in a high-volume patient services program preferred

Experience with Salesforce CRM preferred

Proficient with MS Word, MS Excel, and MS PowerPoint

Working hours may vary based on business needs and team coverage