Case Coordinator

This is a fully remote position, open to applicants in Maryland, +1 more state.

📋 Description

• Assist patients in accessing PDPA and VFM products as prescribed by a licensed healthcare provider.

• Manage and oversee each patient's journey from HUB enrollment to post-fill follow-up.

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

• Provide education to patients, caregivers, and healthcare providers concerning reimbursement, access, and coverage matters.

• Perform benefits investigation and verification, support for prior authorization and appeals, coordinate appointments and baseline assessments, manage Interim Care and voucher administration, copay assistance, prescription triage, and conduct scheduled post-fill follow-up.

• Facilitate Summary of Benefits discussions for all HUB-enrolled patients.

• Collect missing information from Patient Enrollment Forms and verify testing, voucher, and Interim Care options.

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

• Confirm product and baseline-test coverage across PBM and major medical insurance for VFM.

• Supervise the submission and verification of prior authorizations with patients and providers.

• Conduct benefit investigation and verification calls with payers and patients.

• Communicate the requirements for coverage, cost, authorization, appeal, Interim Care, and baseline assessments.

• Schedule, reschedule, and confirm patient appointments while coordinating assessment testing with vendors.

• Manage Interim Care program requirements, deadlines, extended programs, vouchers, copay cards, and eligibility attestations.

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

• Reach out to patients 10 and 45 days post-prescription to address any logistical or financial inquiries.

• Manage and update cases in Polaris utilizing texting, faxing, and prescription triage features.

• Review prior authorization, appeal, and Patient Enrollment Form documentation for accuracy.

• Share and oversee cases with HUB partners and coordinate with Pfizer colleagues and Patient Support Program/HUB staff.

• Maintain real-time case comments and document every interaction with healthcare providers and patients.

• Utilize Kite works encrypted email and manage DocuSign consent collection.

• Report adverse events while adhering to company content controls, permissions, compliance guidelines, and procedures.

• Connect patient access support to individual patient needs using Brand RC-approved materials.

• Collaborate cross-functionally with internal and external colleagues to enhance the patient access journey.

• Build trust through compliant follow-up and a deep understanding of the access journey.

⛳️ Requirements

• A B.S. or B.A. Degree is required.

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

• At least 6 months of experience as a FRM, PAC, FAS, or similar role focused on access and reimbursement, and familiarity with Polaris CRM System.

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

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

• Experience conducting benefit investigations and verifications directly with payers.

• Understanding of prior authorization and appeals processes.

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

• Capability to manage a high volume of concurrent cases with thorough documentation and follow-through.

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

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

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

• Alignment with HQ stakeholders to facilitate patient access.

• Candidates must have authorization 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 required.

• Willingness to travel approximately 10% to 20% as necessary.

• Flexibility to work across different time zones if required.

• 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 Kite works or similar encrypted email platforms, DocuSign, and copay portal management.

• Nice-to-have: Coordination with third-party vendors for patient assessments, testing, or specialty pharmacy logistics.

• Nice-to-have: Experience with interim care, free goods, or bridge programs.

• Nice-to-have: Knowledge of pharmacy benefit and major medical benefit coverage.

• Excellent written and verbal communication abilities.

• Exceptional relationship-building skills, particularly with elderly populations.

• Strong attention to detail and organizational capabilities.

• Outstanding critical thinking skills.

• Excellent collaboration and networking skills.

• Understanding of specialty pharmaceuticals and patient journeys.

• Adherence to regulatory and compliance standards.

🏝️ Benefits

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

• Eligibility to participate in Pfizer’s 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.

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

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

• Opportunity for remote work from home five days a week.