Case Coordinator

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

📋 Description

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

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

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

• Conduct investigations and verifications of benefits, including discussions on Summary of Benefits.

• Acquire missing information from Patient Enrollment Forms and confirm testing, voucher, and Interim Care options.

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

• Verify coverage for products and baseline tests across PBM and major medical insurance.

• Oversee prior authorization requests, verification processes, and support for appeals.

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

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

• Coordinate patient assessment testing with IQVIA/MDX.

• Manage the requirements, deadlines, and Extended Interim Care programs of the Interim Care program.

• Confirm voucher eligibility and manage vouchers for shipment.

• Maintain access to the copay portal and assist patients with copay cards.

• Handle prescription, voucher, and Interim Care fills within Polaris.

• Reach out to patients at 10 and 45 days post-prescription for follow-up.

• Manage case records, documentation, texting, faxing, and prescription triage in Polaris.

• Collaborate and share cases with HUB partners.

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

• Keep real-time case comments and manage DocuSign consents.

• Report adverse events and adhere to company compliance, safety, confidentiality, and communication standards.

• Work cross-functionally to enhance patient access journeys and resolve access challenges.

⛳️ Requirements

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

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

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

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

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

• Experience performing benefit investigations and verifications directly with payers.

• Solid understanding of prior authorization and appeals processes.

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

• Capability to manage a high volume of concurrent cases throughout a patient’s journey.

• Ability to fulfill adverse event reporting responsibilities.

• Comprehensive 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.

• Experience in a patient or customer-facing role that necessitated education on access and reimbursement.

• Background working with a HUB.

• Familiarity with Kite Works or a similar encrypted email platform, DocuSign, and copay portal administration.

• Experience coordinating with third-party vendors in patient assessment, testing, or specialty pharmacy logistics.

• Knowledge in supporting Interim Care, free goods, or bridge programs.

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

• Willingness to work across various time zones if necessary.

• Candidates must possess authorization to work in the U.S. for any employer.

• This role requires permanent work authorization in the United States.

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

🏝️ Benefits

• 401(k) plan with Pfizer Matching Contributions and an additional Pfizer Retirement Savings Contribution.

• Paid vacation, holidays, and personal days.

• Paid caregiver/parental leave and medical leave.

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

• Global Performance Plan with a bonus target of 20.0% of base salary.

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

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