Senior Benefits & Reimbursement Specialist

We are seeking a Senior Benefits & Reimbursement Specialist to support timely patient access to care by managing an assigned caseload of benefits investigations, prior authorizations, and appeals for a growing healthcare organization. This position is a full time, hybrid opportunity with work from home flexibility following initial training. This role serves as the primary point of contact for assigned patients and provider offices, partnering with insurance carriers and internal teams to resolve coverage issues and keep care on track.

The following information provides an overview of the skills, qualities, and qualifications needed for this role.
This position is well aligned for a reimbursement professional with experience managing an independent caseload and navigating complex coverage requirements. The successful candidate will bring a strong understanding of medical and pharmacy benefits, sound judgment, and a consistent focus on accuracy and follow through.
Responsibilities:Own an assigned caseload of patients and provider offices from referral through final coverage resolutionLead benefits investigations across medical and pharmacy benefits and determine the best coverage path for each casePrepare, submit, and manage prior authorizations through to a decisionAnalyze denials, build appeals with supporting documentation, and pursue them through each level of reviewServe as the primary contact for payers on assigned cases, confirming plan requirements, coverage details, and authorization statusIdentify coverage risks early and resolve barriers such as delays, denials, and plan restrictions before they affect patient careConnect eligible patients with financial assistance resourcesKeep provider offices and internal teams informed with timely, accurate case updatesDocument all patient and payer interactions accurately and in line with HIPAA requirementsHandle complex and escalated cases using sound judgment and established protocolsPrioritize a full caseload independently while meeting service level and turnaround goals
Qualifications:High school diploma or equivalentHealthcare certification such as CPhT, CPC, or CRCR is a plus2+ years of direct reimbursement experience managing an assigned caseload, including benefits investigation, prior authorization, appeals, and payer communicationBackground in a healthcare, insurance, or patient services settingStrong working knowledge of medical and pharmacy benefit structures and coverage determinationsPreferred: experience with commercial, Medicare, Medicaid, and government plansPreferred: experience in a patient support role with ownership of provider relationshipsStrong written and verbal communication with close attention to detailProven ability to manage priorities independently and meet service level goals
Schedule:Full time, 40 hours per week, Monday through FridayHybrid: on site during initial paid training, with work from home flexibility beyond trainingShifts are scheduled between 8:00 AM and 8:00 PM ESTEquipment provided; reliable home internet requiredCandidates must reside within commuting distance of the Greater Pittsburgh area
Salary Range:The salary range for this position is approximately $45,760 to $62,400 annually ($22 to $30 per hour), based on experience and qualifications.
Interview Process:Selected candidates will begin with an initial screening with TalentLNX, followed by a final interview with the patient services leadership team. xzbcwsv
Equal Opportunity Employer:TalentLNX is committed to equal employment opportunity and a diverse, inclusive workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, pregnancy, sexual orientation, gender identity, national origin, age, disability, genetic information, veteran status, or any other characteristic protected by applicable federal, state, or local law.