Reimbursement Support Specialist

eTeam; Cambridge (MA); Remote; USD 40,000 - 52,000; Part time

Job summary

eTeam is seeking a Reimbursement Support Specialist for a 6-month, fully remote assignment in the Cambridge, MA area. You will collaborate with Case Management to facilitate insurance reimbursement workflows, verify coverage, and support prior authorizations for the Rare Blood Disorders portfolio.

The role requires 1–3 years in healthcare reimbursement, experience with CRM systems, and strong MS Office skills. A BA/AA degree is preferred and confidentiality with PHI/PII is essential.

Qualifications

• AA degree required; Bachelor's preferred.
• 1-3 years’ experience in health insurance reimbursement or equivalent.
• Discretion handling patient personal data (PII/PHI).
• Proficient with MS Word, MS Excel and MS PowerPoint.
• Experience with Client CRM preferred.

Responsibilities

• Verify insurance coverage policies with providers and ensure prompt, accurate information.
• Identify prior authorization processes and provide documents to Case Management.
• Follow up with payers to determine status of prior authorizations.
• Re-verify insurance benefits as needed for patients.
• Research denied/partial claims to address barriers to treatment.
• Document interactions and data in the CRM per HIPAA requirements.

Skills

MS Word

MS Excel

MS PowerPoint

Communication

Problem-solving

Negotiation

Education

AA Degree

Bachelor's degree

Tools

Client CRM

Job description

Job Title: Reimbursement Support Specialist

Location: Cambridge, MA

Duration: 6 months

Reports To: Director, Case Management Rare Blood Disorders

Fully remote, no travel required. Duration: 6 months with potential for extension. Required: Associate degree, Client CMS/CRM experience, data entry experience, and strong Microsoft Office/365 skills. Experience: 1-3 years of healthcare/pharmaceutical reimbursement or comparable experience preferred. Role involves high-volume payer outreach to obtain and verify insurance information. Preferred: Familiarity with patient assistance programs, enrollment forms, fax processing, billing, and related administrative processes.

About the Job:

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 case, their insurance, coverage approvals, and ongoing coverage requirements in the CRM Database while maintaining compliance with HIPAA and other regulatory 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; Bachelor's 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 Client CRM preferred.
• Proficient with MS Word, MS Excel, and MS PowerPoint.
• Working hours may vary based on business needs and team coverage.