Access & Reimbursement Specialist - National Remote

About Our Client

The organization operates in the healthcare industry, focusing on improving health outcomes through technology-driven care and pharmacy benefits. It addresses challenges related to connecting patients with necessary care, pharmacy benefits, data, and resources to enhance health optimization on a broad scale.

About the Opportunity

This role is responsible for verifying benefits and initiating pharmacy claims to ensure patient access to medications. The position manages prior authorizations, appeals, and financial assistance processes, contributing to the organization's goal of facilitating timely and accurate pharmacy benefit services.

Responsibilities

• Understand and apply pharmacy benefit structures across government and commercial payers.
• Manage pharmacy prior authorization and appeals processes.
• Communicate with pharmacy benefit managers to obtain benefit details and initiate overrides.
• Conduct test claims and electronic benefit verifications.
• Document program-specific information in CRM or database systems.
• Collaborate with licensed healthcare professionals to complete necessary forms.
• Follow up with pharmacy plans and financial assistance organizations on status updates.
• Explain authorization and appeal outcomes to customers clearly.
• Stay informed on copay assistance eligibility and treatment standards related to assigned programs.
• Review and interpret client and customer data.
• Coordinate patient prescription triage to appropriate fulfillment partners.
• Communicate customer statuses as required.
• Troubleshoot and escalate customer issues appropriately.
• Maintain confidentiality and comply with HIPAA regulations.
• Recommend system enhancements to IT partners.
• Complete special projects as assigned.

Requirements

• Minimum 2 years of hands-on pharmacy claims processing and benefit verification experience.
• Ability to work 8-hour shifts Monday to Friday, starting between 10:00am and 11:00am EST.
• Must be 18 years or older.
• Preferred: 2+ years prior authorization processing experience.
• Preferred: Valid pharmacy technician license or certification as required by state regulations.
• Preferred: Specialty pharmacy and pharmacy accreditation experience.
• Preferred: Experience in matrixed, call center, or operations environments.
• Strong independent and team work skills with sound judgment and accountability.

Benefits

• Paid Time Off starting from the first pay period plus 8 paid holidays.
• Medical plan options with Health Spending or Health Saving Accounts.
• Dental, Vision, Life & AD&D insurance.
• Short-term and Long-term disability coverage.
• 401(k) Savings Plan.
• Employee Stock Purchase Plan.
• Education reimbursement.
• Employee discounts.
• Employee Assistance Program.
• Employee referral bonus program.
• Voluntary benefits including pet insurance, legal insurance, and long-term care insurance.

Schedule

8-hour shifts Monday to Friday, starting between 10:00am and 11:00am EST.