Case Coordinator

This is a fully remote position, open to applicants in Illinois.

📋 Description

• Take full ownership of assigned cases, guiding the patient journey from HUB enrollment through to post-fill follow-up.

• Act as the primary contact for patients, caregivers, and healthcare providers concerning reimbursement and access support.

• Address inquiries from patients and caregivers regarding access and coverage.

• Facilitate access for healthcare providers and patients who have opted in to receive PDPA or VFM products.

• Conduct discussions summarizing benefits and review product advantages, costs, and baseline appointments.

• Gather missing information from Patient Enrollment Forms and confirm selections related to testing, vouchers, and Interim Care.

• Clarify out-of-pocket expenses, deductibles, copay options, reimbursement programs, maximizers, and accumulators.

• Verify product and baseline-test coverage with PBM and major medical insurance for VFM.

• Manage submissions for prior authorization, including verification and appeals support.

• Perform benefit investigations and verification calls with payers and patients.

• Communicate requirements regarding coverage, costs, authorization, appeals, Interim Care, and baseline assessments.

• Schedule, reschedule, and confirm patient appointments.

• Coordinate patient assessment tests with IQVIA/MDX and ensure their completion.

• Oversee the requirements, deadlines, and Extended Interim Care programs within the Interim Care program.

• Confirm voucher eligibility and manage the triage of vouchers for shipment.

• Maintain access to the copay portal, assist with copay cards, and manage copay eligibility attestations.

• Conduct follow-ups post-fill to ensure copay card functionality.

• Manage the triage of vouchers, paid prescriptions, and Interim Care fills within Polaris.

• Reach out to patients 10 and 45 days after prescription issuance.

• Handle case types and documentation in Polaris, including texting, faxing, and prescription triage.

• Review prior authorization, appeal, and PEF documentation for precision.

• Share and manage cases in collaboration with HUB partners.

• Coordinate with Pfizer colleagues, Patient Support Program/HUB staff, and third-party vendors.

• Maintain up-to-date case comments and document every interaction with HCPs and patients.

• Utilize Kite works encrypted email and manage DocuSign consents.

• Report any adverse events following company protocols.

• Adhere to content controls, system permissions, compliance guidelines, and procedures.

• Communicate access options using materials approved by Brand RC.

• Collaborate cross-functionally to enhance the patient access journey.

• Connect customer insights to approved resources that address access challenges.

• Build trust through compliant follow-ups and expertise in the access journey.

⛳️ Requirements

• Bachelor’s degree (B.S. or B.A.).

• Over 8 years of experience in pharmaceutical or related fields in customer-facing roles/functions.

• At least 6 months of experience as a FRM, PAC, FAS, or similar role in access and reimbursement, with experience using the Polaris CRM system.

• Proficient in utilizing Polaris, including case management and documentation, prescription triage, and interpreting PA, appeal, and PEF documentation.

• Proven ability to communicate effectively with patients, providers, and cross-functional colleagues.

• Experience in conducting benefit investigations and verifications directly with payers.

• Familiarity with prior authorization and appeals processes.

• Knowledge of copay programs, copay maximizers and accumulators, vouchers, and free or interim care programs.

• Capacity to manage a high volume of concurrent cases in a patient journey averaging around 20 days.

• Ability to fulfill adverse event reporting responsibilities in a role involving frequent patient contact.

• Strong comprehension of reimbursement, government payment systems, specialty pharmacy networks, co-pay assistance programs, and specialty medication.

• Capable of appropriate and compliant communication and collaboration with cross-functional field-based colleagues.

• Alignment with HQ stakeholders to promote patient access.

• Candidates must be authorized to work in the U.S. by any employer.

• U.S. work visa sponsorship is not available now or in the future.

• Permanent work authorization in the United States is mandatory.

• Willingness to travel approximately 10% to 20%.

• Flexibility to work across different time zones if necessary.

🏝️ Benefits

• Target bonus of 20.0% of base salary through Pfizer’s Global Performance Plan.

• Share-based long-term incentive program.

• 401(k) plan with Pfizer matching contributions.

• Additional Pfizer Retirement Savings Contribution.

• Paid vacation, holidays, and personal days.

• Paid caregiver/parental and medical leave.

• Coverage for medical, prescription drugs, dental, and vision.

• Relocation assistance may be provided based on business needs and/or eligibility.

• Option for remote work from home 5 days a week.