Johnson & Johnson Innovative Medicine · 1 day ago
Reimbursement Specialist
United States
Full-time
Remote
Entry, Mid Level
2+ years expJohnson & Johnson is a leader in healthcare innovation dedicated to improving health worldwide. The Reimbursement Specialist will handle payer inquiries, manage benefit investigations, and collaborate cross-functionally to support patient service programs.
Pharmaceuticals
Responsibilities
Assess and analyze patient benefits in coordination with internal program operations, insurance providers, and specialty pharmacy liaisons
Work independently to complete assigned work in accordance with Standard Operating Procedures and defined service levels to review benefit verification process, resolve coverage challenges, and answer inquiries
Use high-level problem-solving skills to research cases and resolve independently using creativity, innovation, and professional judgement to make sound decisions
Maintain frequent phone contact with payers to gather all necessary information related to case/patient information, insurance coverage, prior authorization (PA) and appeals processing
Efficiently process patient and prescriber requests to accelerate access to therapy
Serve as expert on payer trends, product access, and reporting reimbursement insights and/or delays, i.e., denials or delays
Frequently communicate with program management on new insurance requirements and trends
Collaborate with internal & external stakeholders by providing reimbursement information as needed
Maintain accurate, compliant documentation and communication to support program goals
Uphold patient privacy laws and foster collaborative team relationships
Other duties as assigned
Qualification
Required
High school diploma or equivalent
Minimum of 2 years of experience in case management or insurance roles preferably within a pharmacy, HUB, or healthcare setting
Experience using an outbound calling platform to make external calls
Ability to independently manage case load, prioritize work, and use time management skills to meet service level agreements
Ability to efficiently navigate multiple screens and systems to perform work
Ability to work assigned 8 hr shift between program operating hours of 8am-8pm EST
Proven ability to manage a case load, prioritize tasks, and build relationships
Apply company policies and procedures to resolve challenges
Ability to proficiently use Microsoft programs
Ability to thrive in a regulated, remote, high-volume environment
Preferred
Undergraduate Degree
Understanding of plan types – Government, Commercial, Medicaid, VA, Fed
Knowledge of insurance structure (ex PBM's, major medical plans, co-pay assistance /cards)
Working Knowledge of Third-Party and other Foundation programs
Basic understanding of Co-Pay Assistance
Understanding of HUB patient journey, workflow, and triage is a plus
Possess a strong understanding of biologic/specialty pharma market and patient access challenges
Company
Johnson & Johnson Innovative Medicine
Johnson and Johnson Innovative Medicine focuses on developing medical solutions for some of the challenging diseases and medical conditions.
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Molly Perkins
VP, Head of Cell & Genetic Medicines Discovery
Recent News
2025-08-14
Company data provided by crunchbase