Case Manager, Reimbursement

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

📋 Description

• Oversee and coordinate daily case management for an assigned caseload.

• Ensure that case elements and tasks are completed in a timely manner, allowing cases to progress as needed.

• Serve as the primary contact for communications related to prior authorization and appeal processing.

• Engage with patients, healthcare providers, field reimbursement representatives, and other external stakeholders.

• Accurately and promptly communicate patient benefits and responsibilities.

• Evaluate and refer patients to special programs and services as necessary.

• Conduct quality checks on cases and report any trends to leadership.

• Adhere to quality and production standards while complying with company, state, and federal safety and environmental regulations.

• Resolve complex cases across various disease states.

• Collaborate with internal and external stakeholders to ensure a smooth initiation of therapy.

• Report patient Adverse Drug Events in accordance with pharmaceutical requirements.

• Identify product quality complaints and relay caller or written information to the manufacturer.

• Perform additional duties as assigned.

⛳️ Requirements

• A Bachelor’s degree or six years of relevant professional experience.

• Two (2) or more years of pertinent experience in pharmacy benefit management.

• Experience as a Medical Assistant, Social Worker, or Senior Reimbursement Specialist is preferred.

• Certification is preferred but not mandatory.

• Proficient in Microsoft Office applications.

• Familiarity with medical and claims processing terminology.

• Exceptional written and verbal communication skills, including the ability to provide clear instructions.

• Strong critical thinking abilities along with the capability to multitask.

• Availability to work an 8-hour shift between the hours of 8am-8pm EST.

🏝️ Benefits

• Opportunities for remote work.

• Competitive salary packages.

• Opportunities for career advancement and promotion.

• 401K plan with company matching.

• Tuition reimbursement programs.

• Flexible working environment.

• 20 Days of Paid Time Off (PTO).

• Paid holidays.

• Employee assistance programs.

• Comprehensive medical, dental, and vision coverage.

• Health Savings Account (HSA) / Flexible Spending Account (FSA).

• Telemedicine services (virtual doctor appointments).

• Wellness programs.

• Adoption assistance.

• Short-term and long-term disability coverage.

• Life insurance options.

• Various discount programs.