Reimbursement Case Manager

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

📋 Description

• Act as the primary contact and representative for providers and patients.

• Serve as an advocate for patients, enhancing their experience during calls or contacts.

• Coordinate therapy access, perform follow-ups, and facilitate support services.

• Manage caseload in accordance with program specifications.

• Gather and review patient data as permitted by program standard operating procedures (SOPs).

• Confirm necessary information and provide assistance to both providers and patients.

• Assist physician office staff and patients with program applications.

• Assess patient eligibility and oversee enrollment activities, including patient assistance and copay support programs.

• Execute reimbursement tasks such as benefit investigations, prior authorizations, and appeals.

• Offer customer service and address or escalate inquiries and complaints as needed.

• Maintain communication with patients, provider representatives, customer service staff, and pharmacy personnel.

• Supply reimbursement details to providers and patients.

• Report adverse events in line with training and SOPs.

• Collaborate with associates from various departments.

• Record interactions in the CareMetx Connect system while adhering to HIPAA guidelines.

• Ensure consistent and dependable attendance.

• Undertake additional related responsibilities as assigned.

⛳️ Requirements

• A minimum of 3 years of experience in a specialty pharmacy, medical insurance, reimbursement hub, physician’s office, healthcare environment, and/or insurance background is preferred.

• A Bachelor’s Degree is preferred.

• Exceptional verbal and written communication skills.

• Capability to manage multiple tasks and adapt to shifting priorities.

• Proficient typing skills.

• Competence in MS Word and Excel.

• Familiarity with HIPAA regulations.

• Detail-oriented and highly organized.

• Strong interpersonal skills.

• Understanding of pharmacy and medical benefits.

• A comprehensive knowledge of commercial and government payers is preferred.

• Ability and initiative to work independently as well as collaboratively within a team.

• Strong problem-solving skills.

• Focused on customer satisfaction.

• Flexible regarding schedule and hours.

• Overtime may occasionally be required.

• Willingness to work weekends if needed to fulfill company requirements.

• Capability to sit for extended periods and occasionally lift or move up to 10 pounds.

🏝️ Benefits

• CareMetx acknowledges equivalent combinations of experience and education for most positions.

• Practices equal employment opportunity in hiring.

• Provides reasonable accommodations for individuals with disabilities.