Job Specifications
Our client is seeking a highly motivated and detail-oriented Reimbursement Specialist/Coordinator with experience in the laboratory industry, preferably within start-up environments, to support their growing Billing and Market Access team. The ideal candidate has a strong understanding of reimbursement processes, payer policies, and healthcare data analysis. This role plays a key part in optimizing patient access, facilitating billing and reimbursement processes, and generating actionable insights from reimbursement data.
Responsibilities
Serve as the subject matter expert on reimbursement strategies for our product(s), including medical benefit verification, prior authorizations, coding, appeals, and denials.
Analyze reimbursement data and KPIs to identify trends, gaps, and opportunities for process optimization.
Collaborate cross-functionally with Commercial, Medical Affairs, Compliance, and Finance to inform decision-making and streamline access operations.
Monitor changes in payer coverage, CMS guidelines, and coding updates that may impact product reimbursement.
Support the development of patient access programs and reimbursement in collaboration with Market Access and Customer Service.
Assist in training team members in reimbursement processes and best practices.
Utilize data visualization tools (e.g., Excel, Tableau,) and RCM systems to track, report, and communicate reimbursement metrics.
Required Qualifications
Bachelor's degree in Health Sciences, Business, Public Health, or a related field.
1-3+ years of experience in reimbursement, patient access, or revenue cycle, with at least 2 years in healthcare space.
Proven experience working in or with start-up or early-stage companies.
Strong analytical skills: ability to analyze large datasets and provide insights related to reimbursement trends.
Familiarity with reimbursement codes (HCPCS, CPT, ICD-10) and payer policy landscapes.
Experience with reimbursement analytics tools
Excellent communication skills, with the ability to present complex reimbursement topics clearly to internal and external stakeholders.
Comfortable working in a fast-paced, dynamic environment with evolving priorities.
Preferred Qualifications
Experience supporting a product from pre-commercial to commercial launch in a biotech setting.
Experience with third-party HUBs, hospital systems, and patient support programs.
Familiarity with claims data sets and payer adjudication logic.
Bi-lingual: Spanish and English
About the Company
Founded in 2012, Planet Pharma has a dedicated team of seasoned professionals with extensive experience supporting the Life Sciences industry, specifically:
- Medical Device
- Pharmaceuticals
- Diagnostics
- Biotechnology
- CRO
- CMO
- Specialty Providers
- Labs/ Healthcare
Our goal is to create an organization that strengthens the employer-employee dynamic by connecting clients with talent — ultimately making staffing more personal and creating enduring, valuable relationships. We achieve this by leveraging cuttin...
Know more