Reimbursement Specialist / Senior Reimbursement Specialist

W2 Contract

Pay Rate: $70 - $80 per hour

Location: South San Francisco, CA - Remote Role

Job Summary:

As a Reimbursement Specialist (RS), you are the critical link between our life-changing therapies and the patients who need them. You will lead the investigation of complex insurance coverage across both Major Medical and Pharmacy benefits, navigating the intricate landscape of Prior Authorizations (PA) to ensure no patient is left behind due to administrative barriers.

Duties and Responsibilities:

• Conduct comprehensive benefit investigations (BI) to determine coverage pathways, including payer-specific requirements for medical necessity and documentation.
• Proactively manage Prior Authorization and appeals processes; engage with payers to expedite decisions and resolve delays.
• Serve as a primary point of contact for the Patient Services team, providing timely updates on case status and reimbursement insights.
• Communicate with payers and other stakeholders as needed, including participating in inbound and outbound calls to support program and case progression.
• Demonstrate strong attention to detail and the ability to effectively prioritize in a fast-paced environment.
• Ensure full compliance with HIPAA, OIG, and internal policies.

Requirements and Qualifications:

• 3+ years of experience in pharmaceutical/biotech reimbursement, within a Patient Hub or healthcare provider setting; experience supporting complex therapies or rare/orphan diseases preferred
• Proven ability to conduct thorough benefit investigations and navigate complex coverage pathways
• Strong experience managing Prior Authorization and appeals processes, including proactive payer follow-up
• Deep understanding of Buy & Bill and Pharmacy Benefit workflows, including CPT/HCPCS coding and ICD-10 medical necessity requirements
• Excellent verbal and written communication skills, with the ability to explain complex insurance concepts clearly and empathetically to clinical teams and patient families
• Exceptional attention to detail and ability to manage multiple priorities
• Demonstrated ability to work within HIPAA, OIG, and internal compliance guidelines
• Exceptional verbal and written skills; ability to explain complex insurance concepts with empathy and clarity

Bayside Solutions, Inc. is not able to sponsor any candidates at this time. Additionally, candidates for this position must qualify as a W2 candidate.

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