Senior Coordinator, Case Manager

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

📋 Description

• Act as the initial point of contact for incoming calls, assessing needs and addressing inquiries.

• Promptly create and finalize accurate enrollment applications.

• Examine forms and accompanying documentation for any missing or new information.

• Conduct outbound communications and calls to both patients and providers.

• Address questions from patients and representatives regarding the status of assistance requests.

• Update internal treatment plans and the statuses of external pharmacy treatments.

• Keep precise interaction notes in the designated database.

• Perform self-audits of intake activities to ensure accuracy and efficiency.

• Inform patients, physicians, practitioners, and clinics about relevant financial responsibilities.

• Evaluate patients’ financial capability to afford therapy and assist them in acquiring financial support.

• Follow up on rejected benefit investigations, including prior authorizations and appeals.

• Monitor payer and plan issues, reporting changes, updates, and trends to management.

• Research insurance options and clarify programs to help patients choose coverage.

• Manage regional escalations and communicate resolutions within set timelines.

• Serve as a liaison between the client sales team and relevant parties.

• Mediate conflicts and foster favorable outcomes.

• Handle multiple outstanding issues and resolve them in a timely manner.

• Report regional payer issues to the appropriate team.

• Investigate payer, physician office, and pharmacy issues to resolve them quickly.

• Utilize advanced specialty knowledge to independently tackle complex problems.

• Adjust processes as necessary and provide guidance or technical support to less experienced team members.

⛳️ Requirements

• Prior customer service experience is required.

• Experience in Patient Support Services is preferred.

• Strong knowledge of Medicare (A, B, C, D), Medicaid, and Commercial payer policies and coverage guidelines is preferred.

• Familiarity with DME and MAC practices is preferred.

• Solid understanding of Medical, Supplemental, and pharmacy insurance benefit practices is preferred.

• 1-2 years of experience in Pharmacy and/or Medical Claims billing and coding is required.

• 1-2 years of experience with Prior Authorization and Appeal submissions is required.

• Ability to collaborate within high-volume production teams with a focus on quality.

• Intermediate to advanced computer skills, including proficiency in Microsoft Office, especially Word, Outlook, and preferably Excel.

• Previous medical experience is preferred.

• Bilingual candidates are preferred.

• Attendance at mandatory new hire training from 8:00 am to 5:00 pm CST is required.

• Flexibility to work any shift from Monday to Friday between 7:00 am and 7:00 pm CST is required.

• A dedicated, quiet, and private remote work environment free from distractions is essential.

• A high-speed broadband internet connection that meets specified requirements: 15Mbps download, 5Mbps upload, with a maximum 30ms ping rate, and hardwired to the router is required.

• A surge protector with Network Line Protection for company-issued equipment is necessary.

🏝️ Benefits

• Comprehensive medical, dental, and vision coverage.

• Paid time off plan.

• Health savings account (HSA).

• 401k savings plan.

• Access to wages before payday through myFlexPay.

• Flexible spending accounts (FSAs).

• Short- and long-term disability coverage.

• Work-Life resources.

• Paid parental leave.

• Healthy lifestyle programs.

• Company-provided computer, technology, and equipment necessary to perform the job.

• Bonus eligible: No.