Case Coordinator

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

📋 Description

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

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

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

• Facilitate access for healthcare providers and patients/caregivers who are prescribed PDPA or VFM products.

• Conduct discussions on the Summary of Benefits for patients enrolled in the HUB.

• Gather and verify any missing information from the Patient Enrollment Form, including testing, vouchers, and Interim Care options.

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

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

• Manage the submission and verification of prior authorizations and provide appeals support.

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

• Communicate details about coverage, costs, prior authorization, appeal requirements, deadlines, and baseline assessment tests.

• Schedule, reschedule, and confirm patient appointments with patients, healthcare providers, and vendors.

• Coordinate patient assessment testing with IQVIA/MDX.

• Oversee Interim Care program requirements and timelines.

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

• Maintain access to the copay portal, assist patients in securing copay cards, and handle eligibility attestations.

• Follow up after filling prescriptions to ensure copay card functionality.

• Triage voucher, paid prescription, and Interim Care fills within Polaris.

• Reach out to patients 10 and 45 days after prescriptions to address logistical or financial inquiries.

• Manage case types in Polaris utilizing texting, faxing, and prescription triage capabilities.

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

• Share and oversee cases with HUB partners.

• Collaborate with Pfizer colleagues and Patient Support Program/HUB staff to resolve patient-case issues.

• Document all HCP and patient calls in real-time case comments.

• Utilize Kiteworks encrypted email and manage DocuSign consents.

• Report adverse events as per company requirements.

• Communicate access options in compliance with Brand RC-approved materials.

• Maintain discretion and confidentiality while adhering to compliance protocols.

• Collaborate across functions to enhance the patient access journey and eliminate access barriers.

⛳️ Requirements

• Bachelor of Science or Bachelor of Arts degree.

• 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, along with experience using the Polaris CRM System.

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

• Proven ability to communicate effectively with patients, providers, and colleagues from various functions.

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

• Familiarity with prior authorization and appeals processes.

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

• Capability to manage a high volume of concurrent cases throughout a patient journey averaging approximately 20 days, with disciplined documentation and follow-through.

• Ability to fulfill adverse event reporting responsibilities in a role that involves frequent, direct patient contact.

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

• Effective and compliant communication and collaboration with cross-functional field-based colleagues.

• Alignment with HQ stakeholders to enhance patient access.

• Candidates must have authorization to work in the U.S. with any employer.

• Sponsorship for U.S. work visas is not currently available and will not be in the future.

• Position requires permanent work authorization in the United States.

• Willingness to travel approximately 10% to 20%.

• Flexibility to work across different time zones as needed.

• Nice-to-have: Experience in patient/customer-facing access and reimbursement education.

• Nice-to-have: Experience working with a HUB.

• Nice-to-have: Familiarity with Kiteworks or similar encrypted email platforms, DocuSign, and copay portal management.

• Nice-to-have: Experience coordinating with third-party vendors on patient assessments, testing, or specialty pharmacy logistics.

• Nice-to-have: Experience supporting Interim Care, free goods, or bridge programs.

• Nice-to-have: Experience with pharmacy benefit (PBM) and major medical benefit coverage.

• Excellent written and verbal communication skills.

• Strong attention to detail and organizational capabilities.

• Exceptional critical thinking abilities.

• Understanding of specialty pharmaceuticals and patient journeys.

• Adherence to regulatory and compliance standards.

🏝️ Benefits

• 401(k) plan with matching contributions from Pfizer.

• Additional retirement savings contribution from Pfizer.

• Paid vacation, holidays, and personal days.

• Paid caregiver/parental and medical leave.

• Comprehensive medical, prescription drug, dental, and vision coverage.

• Bonus target of 20.0% of base salary through Pfizer’s Global Performance Plan.

• Eligibility to participate in Pfizer’s share-based long-term incentive program.

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