Case Coordinator

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

📋 Description

• Take complete ownership of assigned cases and guide the patient journey from HUB enrollment through follow-up after prescription fulfillment.

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

• Address inquiries from patients and caregivers related to access and coverage.

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

• Conduct discussions about Summary of Benefits with every HUB-enrolled patient.

• Gather any missing information from the Patient Enrollment Form and confirm selections for testing, vouchers, and Interim Care.

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

• Verify coverage for products and baseline tests with Pharmacy Benefit Managers (PBM) and major medical insurance for VFM.

• Oversee submissions for prior authorization, verification, and appeals assistance.

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

• Relay information regarding coverage, costs, authorization, appeals, Interim Care, and baseline assessment needs.

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

• Coordinate patient assessment tests with IQVIA/MDX.

• Manage the requirements and deadlines associated with the Interim Care program and Extended Interim Care initiatives.

• Verify voucher eligibility and manage the triage process for voucher shipments.

• Maintain access to the copay portal and assist eligible patients in obtaining copay cards.

• Handle copay eligibility attestations and follow up on post-fill copay matters.

• Triage vouchers, paid prescriptions, and Interim Care fills within the Polaris system.

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

• Manage different case types in Polaris using capabilities such as texting, faxing, and prescription triage.

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

• Share and manage cases alongside HUB partners.

• Collaborate with Pfizer colleagues, the Patient Support Program, and HUB staff to resolve case-related issues.

• Maintain up-to-date case comments, documenting every interaction with healthcare providers and patients.

• Utilize Kite works encrypted email and manage DocuSign consents.

• Report any adverse events in accordance with company policies.

• Comply with access options using Brand RC-approved materials.

• Uphold confidentiality and adhere to Pfizer compliance guidelines.

• Collaborate across functions with both internal and external colleagues to enhance patient access.

• Connect customer insights with approved resources to address barriers to patient access.

⛳️ Requirements

• Bachelor of Science (B.S.) or Bachelor of Arts (B.A.) degree.

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

• A minimum of 6 months experience as a FRM, PAC, FAS, or similar role focused on access and reimbursement while utilizing the Polaris CRM system.

• Proficient in Polaris, with expertise in case management, documentation, prescription triage, and understanding prior authorization, appeals, 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, maximizers, accumulators, vouchers, and free or interim care programs.

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

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

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

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

• Alignment with headquarters stakeholders to support patient access initiatives.

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

• Permanent work authorization in the United States is mandatory.

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

• Willingness to travel approximately 10% to 20% of the time.

• Availability during Eastern Time Zone hours.

• Preferred: Experience in patient/customer-facing education on access and reimbursement.

• 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 assessment, testing, or specialty pharmacy logistics.

• Preferred: Experience in supporting Interim Care, free goods, or bridge programs.

• Preferred: Knowledge of pharmacy benefit (PBM) and major medical benefit coverage pathways.

• Excellent written and verbal communication abilities.

• Strong attention to detail and organizational skills.

• Exceptional critical thinking capabilities.

• Understanding of Specialty Pharmaceuticals and patient journeys.

• Adherence to regulatory and compliance standards.

🏝️ 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 contributions matched by Pfizer.

• Additional retirement savings contributions from Pfizer.

• 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.

• Remote work from home 5 days a week for remote colleagues.