Job description

About the Role

The Reimbursement Resource Specialist position is a contract role based in Cambridge, MA, offering full remote work with initial onsite training required. The contract extends through January 2027, with potential for extension. This role supports the Case Management team within Patient Support Services, primarily focusing on rare hematology and oncology portfolios. The specialist facilitates reimbursement processes, insurance benefit verifications, and enrollment support for patients.

Key Responsibilities

Verify insurance coverage and benefits by liaising directly with medical insurance providers to enable timely treatment initiation.
Research prior authorization procedures for insurance plans and communicate necessary documentation to the Case Management team.
Re-verify insurance benefits as needed to support patient and facility services.
Assist in resolving co-pay claim issues related to Co-Pay Assistance Programs.
Maintain current knowledge of reimbursement procedures, healthcare policies, payer trends, and financial assistance offerings.
Document all interactions and case details accurately in the iCare Database while ensuring HIPAA compliance.
Develop proficiency in the Rare Blood Disorders and Oncology Patient Support Services CRM, understanding case statuses and documentation requirements.
Report Adverse Events and Product Technical Complaints following regulatory guidelines.
Support Specialty Pharmacy referral processes and manage shared email inboxes related to Case Management.

Required Qualifications and Skills

Bachelor's degree or higher in relevant fields.
Four to five years of experience in health insurance reimbursement, medical billing, or comparable roles.
Strong communication, problem-solving, and negotiation capabilities.
Critical thinking and ability to operate independently in fast-paced environments.
Proficiency with Microsoft Office 365 tools including Word, Excel, and PowerPoint.
Attention to detail, strong organizational skills, and adherence to operational procedures and regulatory compliance.

Preferred Skills

Familiarity with Salesforce CRM and patient assistance programs.
Experience working in high-volume patient service environments.
Understanding of administrative tasks such as managing enrollment forms, faxes, and billing processes.

Additional Information

The initial training will take place onsite at 450 Water Street, Cambridge, MA, expected within 2-3 months after the start date, lasting one week.
Work schedule is Monday to Friday, 9:00 AM to 5:00 PM Eastern Standard Time.
Minimal travel may be required for training or team meetings; travel expenses will be reimbursed.
The role reports to the Senior Director of Operations and Case Management.