Reimbursement Specialist

Job Summary
We are hiring a full-time Reimbursement Specialist to join the patient services team at a well-established specialty healthcare organization. In this work-from-home role, you will manage the full reimbursement cycle for patients, guiding them through insurance coverage, prior authorizations, and financial assistance so they can start and stay on therapy. You will work closely with payers, internal teams, and provider offices to resolve access barriers and keep cases moving forward.

This role requires 4 to 6 weeks of paid on-site training at our Pittsburgh, PA office before transitioning to a permanent remote schedule. All equipment is provided. Scheduling operates on a rotating, flexible basis between 8:00 AM and 8:00 PM, Monday through Friday.

If you have a strong reimbursement background, enjoy working independently, and want to be part of a team that directly impacts patient outcomes, we want to hear from you.

Responsibilities

• Serve as a primary point of contact for payer and reimbursement inquiries, managing cases from intake through resolution
• Conduct benefits investigations and verify pharmacy and/or medical insurance coverage
• Manage prior authorization submissions, follow-up communications, denial reviews, and appeals processing
• Communicate frequently with payers to obtain accurate coverage details, authorization status, and plan requirements
• Connect eligible patients with copay assistance programs and available financial support resources
• Identify and resolve access barriers, including coverage delays, denials, underpayments, and step therapy requirements
• Collaborate with internal teams and provider offices to share reimbursement updates and keep patients on track
• Document all patient and payer interactions accurately and in full compliance with patient privacy requirements
• Escalate complex cases appropriately using professional judgment and established protocols

Requirements

• High school diploma required
• Minimum 2 years of direct reimbursement experience including benefits investigation, prior authorizations, and payer communications
• Background in a pharmacy, healthcare, or insurance-related environment
• Understanding of pharmacy and/or medical benefit structures and coverage determination processes
• Ability to manage an independent caseload, prioritize work, and meet defined service levels
• Strong written and verbal communication skills with a focus on accuracy and professionalism
• Must be within commuting distance of Pittsburgh, PA and available to report on-site for the initial 4 to 6 week training period
• Reliable home office setup with stable internet connection required; all equipment provided

Preferred Requirements

• Certified Pharmacy Technician (CPhT) or similar healthcare credential
• Experience with complex or high-cost medications and patient access challenges
• Knowledge of commercial, government, Medicaid, VA, or Federal plan types
• Familiarity with PBMs, copay assistance programs, or patient financial assistance resources
• Background in a patient support, case management, or reimbursement services environment
• Strong analytical and organizational skills with meticulous attention to detail

Pay: $20.00 - $30.00 per hour

Benefits:

• 401(k) matching
• Dental insurance
• Flexible schedule
• Health insurance
• Life insurance
• Paid time off
• Professional development assistance
• Vision insurance
• Work from home

Application Question(s):

• This role is scheduled as a standard 8-hour shift, with start times falling anywhere between 8:00 AM and 8:00 PM, Monday through Friday, on a rotating basis. Are you available to work any 8-hour shift within that window?
• Are you within commuting distance of Pittsburgh, PA and able to report on-site for an initial 4 to 6 week paid training period?
• Do you have 2 or more years of direct reimbursement experience including benefits investigation, prior authorizations, and payer communications?

Work Location: Remote