Reimbursement Specialist (Healthcare)

TL;DR

Reimbursement Specialist (Healthcare Operations): Providing reimbursement support for benefit coverage, prior authorizations, and claim appeals for patients and healthcare providers with an accent on pharmacy reimbursement and insurance verification. Focus on navigating complex payer requirements, managing prior authorizations, and ensuring patients receive necessary therapy coverage.

Location: Mason, OH, USA (Onsite)

Company

hirify.global provides next-generation commercialization services to the life sciences industry, serving a wide range of biotech and pharmaceutical clients.

What you will do

• Provide personalized support to patients, HCPs, and payers via phone, CRM, and email.
• Investigate and answer questions regarding insurance benefits, coverage, and out-of-pocket costs.
• Assist with prior authorizations, medical necessity processes, and benefit verifications.
• Triage inquiries to appropriate third-party support centers.
• Conduct enrollment intake for all incoming inquiries.
• Participate in continuous quality improvements and training opportunities.

Requirements

• Strong pharmacy reimbursement experience, specifically regarding the prior authorization process.
• Experience conducting benefit verifications with payers for retail prescription drug products.
• Knowledge of healthcare administration, billing, and reimbursement regulations.
• Excellent oral, written, and interpersonal communication skills.
• Proficiency in Microsoft Word, Excel, and PowerPoint.
• Must be able to work rotating 8-hour shifts Monday through Friday.

Nice to have

• Customer service or contact center experience.
• Direct Reimbursement/Patient Services experience.
• Knowledge of Retail Pharmacy Operations.

Culture & Benefits

• Certified as a Great Place to Work globally.
• Inclusive culture that embraces diversity in backgrounds and experiences.
• Competitive salaries and comprehensive benefits package.
• Patient-minded approach focused on the best interests of the patient.
• Empowered environment that encourages bold innovation and taking action.