Case Manager, Reimbursement

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

📋 Description

• Oversee and coordinate the day-to-day management of assigned cases.

• Ensure timely completion of case elements and tasks, facilitating the progression of cases through the required processes.

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

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

• Accurately and promptly communicate patient benefits and responsibilities.

• Assess patients for appropriate referrals to special programs and services.

• Conduct quality checks on cases and report trends to management.

• Resolve complex cases that involve multiple disease states.

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

• Perform pre-screening to determine eligibility for injection services, co-pay assistance, and patient support programs when relevant.

• Maintain precise documentation of payer information and patient status.

• Carry out additional tasks as assigned.

⛳️ Requirements

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

• At least two (2) years of pertinent experience in pharmacy benefit management.

• Background in full benefits investigation is required.

• Experience with Patient Assistance Programs (PAP) is preferred.

• Certification is preferred but not mandatory.

• Proficiency in Microsoft Office applications is essential.

• Familiarity with medical and claims processing terminology is required.

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

• Strong critical thinking abilities are necessary.

• Capability to handle multiple tasks simultaneously.

• Experience with Salesforce is preferred.

• Must adhere to applicable company, state, and federal safety and environmental policies and procedures.

• Required to report Adverse Drug Events in compliance with pharmaceutical regulations.

• Must identify product quality complaints and relay the information to the manufacturer.

🏝️ Benefits

• Remote work opportunities.

• Opportunities for career advancement.

• 401K plan with company match.

• Tuition reimbursement program.

• Flexible work environment.

• Paid Time Off (PTO).

• Paid holidays.

• Employee assistance programs.

• Medical, dental, and vision insurance.

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

• Telemedicine services (virtual doctor appointments).

• Wellness program.

• Adoption assistance.

• Short-term disability coverage.

• Long-term disability coverage.

• Life insurance.

• Employee discount program.