Job Description

Be the Bridge Between Patients and the Life-Changing Care They Deserve

Title: Reimbursement Specialist

Location Fully Remote |  Must reside in TX, NC, SC, TN, KY, IN, GA, or AZ

Compensation & Schedule

• $18–$20/hr

• Full-time; available to work an 8-hour shift between 7:00 AM–7:00 PM Monday–Friday

• Seasonal role starting 11/3/25 through early 2026

• W2 employment

ROLE IMPACT

The Reimbursement Specialist plays a critical role in ensuring patients receive timely access to prescribed therapies by managing insurance benefit investigations, prior authorization submissions, and payer communications. Success in this role is defined by accurate and efficient processing of reimbursement requests, proactive resolution of provider and patient inquiries, and consistent adherence to program standard operating procedures to optimize the patient experience.

KEY RESPONSIBILITIES

• Conduct benefit investigations and review patient insurance information per program SOPs.

• Complete, submit, and track prior authorization requests to third-party payers, ensuring timely follow-up.

• Provide exceptional customer service to providers, patients, payers, and internal teams, escalating issues as necessary.

• Maintain accurate documentation of all interactions in the CareMetx Connect system.

• Coordinate with interdepartmental teams to resolve reimbursement barriers and communicate payer updates.

MINIMUM QUALIFICATIONS

• High School Diploma or GED.

• 2+ years of experience in specialty pharmacy, medical insurance, physician’s office, healthcare, or related setting.

• Strong verbal and written communication skills with ability to build productive relationships.

• General knowledge of pharmacy and medical benefits; familiarity with commercial and government payers preferred.

• Proficiency with Microsoft Excel, Outlook, and Word.

CORE TOOLS & SYSTEMS

• Microsoft Excel

• Microsoft Outlook

• Microsoft Word

PREFERRED SKILLS

• Strong organizational and time management skills with attention to detail.

• Negotiation skills to resolve payer and reimbursement challenges.

• Problem-solving mindset with ability to work independently or in a team.

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