Case Coordinator

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

📋 Description

• Take full ownership of designated patient cases and guide the patient journey from HUB enrollment through to post-fill follow-up.

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

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

• Perform benefits investigation and verification, encompassing product and baseline-test coverage.

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

• Collect any missing Patient Enrollment Form information and confirm testing, voucher, and Interim Care selections.

• Oversee prior authorization submissions, including verification, appeals support, and adherence to deadlines.

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

• Schedule, reschedule, and confirm patient appointments and baseline assessments.

• Coordinate patient assessment testing with IQVIA/MDX and other vendors.

• Manage the administration of the Interim Care program, including Extended Interim Care programs.

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

• Maintain access to the copay portal, assist eligible patients in obtaining copay cards, and oversee copay eligibility attestations.

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

• Follow up with patients 10 and 45 days after prescription issuance to address any logistical or financial inquiries.

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

• Review documentation related to prior authorization, appeals, and Patient Enrollment Forms.

• Share and manage cases with HUB partners while coordinating with Pfizer colleagues and Patient Support Program/HUB staff.

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

• Utilize Kite Works encrypted email and manage the DocuSign consent procedures.

• Report adverse events in compliance with company requirements.

• Ensure compliant communication using Brand RC-approved materials and adhere to company compliance guidelines.

• Collaborate across functions to enhance the patient access journey and tackle access challenges.

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

⛳️ Requirements

• B.S. or B.A. Degree.

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

• A minimum of 6 months as a FRM, PAC, FAS, or in a similar position related to access and reimbursement, with experience using the Polaris CRM System.

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

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

• Experience performing 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.

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

• Ability to meet adverse event reporting requirements in a role with frequent direct patient contact.

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

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

• Experience in a patient and/or customer-facing role that involves access and reimbursement education (preferred).

• Experience working with a HUB (preferred).

• Familiarity with Kite Works or similar encrypted email platforms, DocuSign, and copay portal administration (preferred).

• Experience coordinating with third-party vendors for patient assessments, testing, or specialty pharmacy logistics (preferred).

• Experience supporting interim care, free goods, or bridge programs (preferred).

• Knowledge of both pharmacy benefit (PBM) and major medical benefit coverage pathways (preferred).

• Excellent written and verbal communication abilities.

• Outstanding skills in relationship-building, critical thinking, organization, and collaboration.

• Understanding of specialty pharmaceuticals and patient journeys.

• Commitment to regulatory and compliance standards.

• Flexibility to work across various time zones if required.

• Willingness to travel approximately 10% to 20%.

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

• Permanent work authorization in the United States is required; U.S. work visa sponsorship is not available now or in the future.

🏝️ Benefits

• 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.

• 401(k) plan with Pfizer Matching Contributions.

• Additional Pfizer Retirement Savings Contribution.

• Paid vacation, holiday, and personal days.

• Paid caregiver/parental and medical leave.

• Medical, prescription drug, dental, and vision coverage.

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