Insurance Specialist

Job Title: Reimbursement Resource SpecialistInsurance SpecialistDuration: 12 monthsLocation: Cambridge, MA, 02141Work Schedule: M-F 9am-5:30pm (Hybrid)This position's starting pay is: $33.00hr.Job Purpose:The Reimbursement Support Specialist will support and work collaboratively with Case Managers in the Rare Blood Disorders business to support enrollment processing for our Rare Hematology 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 andor healthcare insurance reimbursement experience.Job 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 Co-Pay Assistance Program• Coordinate within the functional Reimbursement Support Specialist team to ensure efficient assignment and distribution of tasks from the shared work queue• 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 andor 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 Rare Blood Disorders 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 Pharmacoviligence in accordance with, Rare Blood Disorders and FDA rules and regulations.Must Have: • Spanish speaking is essentialExperience:• Reimbursement Resource Specialisto 4-5 years' experience in health insurance reimbursement, medical billing, or equivalent applicable work experienceo Effective communication, problem-solving and negotiation skills required.o Ability to think critically and problem solve to address customer needs.o Ability to work collaboratively and independently in a fast-paced environmento Experience working in a high- volume patient services program preferred.o Experience with Salesforce CRM preferred.o Proficient with Microsoft Office, Word, Excel, and PowerPointo Ability to be on-site 2-3 days per week.Education:Bachelor's degree requiredAbout Us: Established in 2004, SPECTRAFORCE® is one of the largest and fastest-growing diversity-owned staffing firms in the US. The growth of our company is a direct result of our global client service delivery model that is powered by our state-of-the-art A.I. proprietary talent acquisition platform, robust ISO 9001:2015ISO 27001 certified processes, and strong and passionate client engaged teams. We have built our business by providing talent and project-based solutions, including Contingent, Permanent, and Statement of Work (SOW) services to over 140 clients in the US, Canada, Puerto Rico, Costa Rica, and India. Key industries that we service include Technology, Financial Services, Life Sciences, Healthcare, Telecom, Retail, Utilities and Transportation. SPECTRAFORCE is built on a concept of "human connection," defined by our branding attitude of NEWJOBPHORIA®, which is the excitement of bringing joy and freedom to the work lifestyle so our people and clients can reach their highest potential. Learn more at: SPECTRAFORCE offers ACA compliant health benefits as well as dental, vision, accident, critical illness, voluntary life, and hospital indemnity insurances to eligible employees. Additional benefits offered to eligible employees include commuter benefits, 401K plan with matching, and a referral bonus program. SPECTRAFORCE provides unpaid leave as well as paid sick leave when required by law.Equal Opportunity Employer: SPECTRAFORCE is an equal opportunity employer and does not discriminate against any employee or applicant for employment because of race, religion, color, sex, national origin, age, sexual orientation, gender identity, genetic information, disability or veteran status, or any other category protected by applicable federal, state, or local laws. Please contact Human Resources at if you require reasonable accommodation.California Applicant Notice: SPECTRAFORCE is committed to complying with the California Privacy Rights Act ("CPRA") effective January 1, 2023; and all data privacy laws in the jurisdictions in which it recruits and hires employees. A Notice to California Job Applicants Regarding the Collection of Personal Information can be located on our website. Applicants with disabilities may access this notice in an alternative format by contacting County, CA Applicant Notice: If you are selected for this position with SPECTRAFORCE, your offer is contingent upon the satisfactory completion of several requirements, including but not limited to, a criminal background check. We consider qualified applicants with arrest or conviction records for employment in accordance with all local ordinances and state laws, including the Los Angeles County Fair Chance Ordinance for Employers (FCO) and the California Fair Chance Act (FCA). The background check assessment will consider whether a criminal history could reasonably have a direct, adverse impact on the job-related safety, security, trust, regulatory compliance, or suitability for this role. Such findings may result in withdrawal of a conditional job offer.At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws.

Created: 2024-11-06