Reimbursement Resource Specialist (Cambridge)

Title : - Reimbursement Resource Specialist

Location : Cambridge, MA (Remote)

Duration : Contract until April 2026 (Possible extension)

Job ID : - SNFIJP00010595

Description : Fully Remote

However initial travel and onsite training will be required for initial 1-2 weeks

2 Roles, please indicate if candidate has a preferred shift or is unable to work specific hours.

Reimbursement Specialist #1 :

Work hours : 9 : 00 AM - 5 : 00 PM (est)

Reimbursement Specialist #2 :

Work hours : 11 : 00 AM - 7 : 00 PM (est)

Department : Patient Support Services

The Reimbursement Support Specialist will support and work collaboratively with Case Managers in the Rare Blood Disorders and Onc business to support enrollment processing for our Rare Hematology and Onc portfolio, assist with the facilitation of the reimbursement process for our Rare Hematology product portfolio, which includes assisting with benefit investigations and being the first in line for inbound calls. 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 and / or healthcare insurance reimbursement experience.

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Key Responsibilities

Assist with the verification of insurance coverage policies and benefit details through direct contact with medical insurance providers with prompt communication of accurate information to facilitate the initiation and ongoing continuation of treatment

Research and identify insurance company prior authorization processes and provide necessary documents and requirements to Case Management team members

Re-verify insurance benefits and coverage as needed to assist the Case Management Team with prompt service for Patients and Facilities

Assist case management team in the resolution of co-pay claim issues related to Sanofi Co-Pay Assistance Program

Maintain up-to-date knowledge of the reimbursement process, healthcare policy, insurance plans, payer trends, financial assistance programs, and related resources

Complete daily documentation of all interactions and input accurate data, which includes inbound phone calls, prescription information, insurance and PBM information, coverage approvals and / or denials, prior authorization information and ongoing coverage requirements in iCare Database while maintaining compliance with HIPAA and other applicable healthcare and privacy regulations

Establish proficiency and full understanding of the Sanofi Rare Blood Disorders and Onc Patient Support Services Customer Relationship database including understanding of data elements, case statuses and outcomes, and documentation requirements

Receive and report all Adverse Events and Product Technical Complaints to Pharmacovigilance in accordance with Sanofi, Rare Blood Disorders and FDA rules and regulations

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Requirements & Qualifications

Required Qualifications

Bachelor's degree required

4-5 years' experience in health insurance reimbursement, medical billing, or equivalent applicable work experience

Effective communication, problem-solving and negotiation skills required

Ability to think critically and problem solve to address customer needs

Ability to work collaboratively and independently in a fast-paced environment

Proficient with Microsoft Office, Word, Excel, and PowerPoint

Ability to travel for required on-site for training for initial 1-2 weeks

Preferred Qualifications

Experience working in a high-volume patient services program preferred

Experience with Salesforce CRM preferred

Travel Requirements

Minimal travel expected, primarily for occasional team meetings or training sessions

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Reporting Structure

Reports to : Senior Director Operations and Case Management

MINAKSHI SANGWAN

Recruiting Lead - US Recruitment

O 732-339-3518

E Minakshi.sangwan@aequor.com

W http : / / www.aequor.com /