Reimbursement Support Specialist

Aequor; Cambridge (MA); On-site; USD 55,000 - 75,000; Full time

Job summary

Aequor is seeking a Reimbursement Support Specialist to assist Case Management for our Rare Blood patient support program. This role supports reimbursement processes, education, and coordination to help patients access prescribed therapies.

Responsibilities include researching insurance coverage, handling prior authorizations, and maintaining accurate CRM documentation while ensuring HIPAA compliance. Strong communication and problem-solving skills are essential.

Qualifications

• AA degree required; BA preferred.
• Experience in health insurance reimbursement or equivalent work.
• Ability to handle sensitive information (PII/PHI) with discretion.

Responsibilities

• Verify insurance coverage and benefit details with providers.
• Identify prior authorization processes and prepare required documents.
• Follow up with payers on prior authorizations and claims status.
• Re-verify insurance benefits for patients as needed.
• Research denied/ incomplete claims to resolve access barriers.
• Document interactions and update CRM with case details per HIPAA rules.
• Provide quality phone customer service to inbound callers.
• Coordinate with team to distribute tasks from the shared queue.

Skills

Communication

Problem solving

Negotiation

Customer service

Education

Associate degree

Bachelor’s degree

Tools

Salesforce CRM

MS Word

MS Excel

MS PowerPoint

Job description

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

Minimum Requirements:

• 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