Case Coordinator

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

📋 Description

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

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

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

• Conduct Summary of Benefits discussions for each HUB-enrolled patient.

• Acquire missing information from the Patient Enrollment Form and verify selections for testing, vouchers, and Interim Care.

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

• Validate product coverage and baseline-test coverage across PBM and major medical insurance.

• Supervise prior authorization submissions, verification processes, and support for appeals.

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

• Relay information on coverage, costs, authorizations, appeals, Interim Care, and baseline assessment requirements.

• Schedule, reschedule, and confirm patient appointments.

• Coordinate patient assessment tests with IQVIA/MDX.

• Oversee requirements, deadlines, and extended programs for the Interim Care program.

• Verify voucher eligibility and triage vouchers for shipment.

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

• Follow up post-fill to ensure copay card functionality.

• Triage vouchers, paid prescriptions, and Interim Care fills in Polaris.

• Contact patients 10 and 45 days following the prescription.

• Manage various case types and documentation in Polaris, including texting, faxing, and prescription triage.

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

• Share and manage cases in collaboration with HUB partners.

• Work alongside Pfizer colleagues, Patient Support Program/HUB employees, and external partners.

• Maintain real-time case comments and call summaries.

• Utilize Kite works encrypted email and manage DocuSign consents.

• Report adverse events in accordance with company guidelines.

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

• Uphold confidentiality and adhere to company compliance protocols.

• Collaborate across functions to enhance the patient access journey.

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

⛳️ Requirements

• Bachelor's degree (B.S. or B.A.).

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

• Minimum of 6 months of experience as a FRM, PAC, FAS, or similar role in access and reimbursement while working with the Polaris CRM System.

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

• Knowledge of prior authorization and appeals processes.

• Familiarity with copay programs, maximizers and accumulators, vouchers, and free or interim care programs.

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

• Ability to fulfill adverse event reporting responsibilities 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.

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

• Alignment with HQ stakeholders to facilitate patient access.

• 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 a similar encrypted email platform, DocuSign, and copay portal administration (preferred).

• Experience coordinating with third-party vendors for patient assessment, 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 skills.

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

• Strong attention to detail and organizational skills.

• Outstanding critical thinking abilities.

• Ability to comprehend complex processes and communicate effectively with diverse patient communities.

• Excellent collaboration and networking skills.

• Ability to thrive in a team environment.

• Understanding of specialty pharmaceuticals and patient journeys.

• Commitment to regulatory and compliance standards.

• Willingness to work across various time zones as needed.

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

• Permanent work authorization in the United States is required.

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

• Willingness to travel approximately 10% to 20%.

🏝️ Benefits

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

• 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.