Reimbursement Case Manager

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

📋 Description

• Serves as a primary contact and representative for all providers and patients.

• Functions as a patient advocate, consistently exhibiting compassion.

• Enhances the caller/contact experience while advocating for patients.

• Facilitates access to therapies, performs appropriate follow-ups, and ensures access to necessary support services.

• Manages a case load based on the program's parameters.

• Gathers and reviews all patient information, in accordance with the program's SOP.

• Validates the completeness of required information and assists providers and/or patients as needed.

• Guides physician office staff and patients on timely completion and submission of all necessary program applications.

• Assesses patient eligibility and oversees patient enrollment activities, such as patient assistance programs and copay assistance.

• Executes reimbursement-related tasks, including benefit investigations, prior authorizations, and appeals.

• Delivers exceptional customer service to both internal and external clients; addresses customer requests promptly and accurately; escalates issues as necessary.

• Maintains regular phone communication with patients, provider representatives, third-party customer service agents, and pharmacy staff.

• Supplies reimbursement information to providers and/or patients.

• Reports all Adverse Events (AE) disclosed, adhering to training and Standard Operational Procedures (SOP).

• Collaborates with inter-departmental associates when necessary.

• Tackles problems of moderate complexity, analyzing data that requires consideration of various factors.

• Exercises judgment within established standard operating procedures to determine suitable actions.

• Generally receives minimal guidance on daily tasks, with general instructions for new assignments.

• Possesses extensive knowledge of HIPAA regulations and adheres to all company policies.

• Maintains consistent and dependable attendance, being punctual and prepared for scheduled work.

• Performs additional related duties as assigned.

⛳️ Requirements

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

• Bachelor's Degree is preferred.

• Strong verbal and written communication skills.

• Capability to multi-task and adapt to shifting priorities.

• Proficient keyboarding skills.

• Competence in MS Word and Excel.

• Familiarity with HIPAA regulations.

• Detail-oriented and highly organized.

• Exceptional interpersonal skills.

• Understanding of pharmacy and medical benefits.

• A broad understanding of commercial and government payers is preferred.

• Ability and initiative to work independently or collaboratively as part of a team.

• Strong problem-solving abilities.

• Focused on customer satisfaction.

🏝️ Benefits

• Health insurance.

• Flexible working hours.

• Paid time off.