Senior Reimbursement Case Manager

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

📋 Description

• Act as the primary point of contact for providers, patients, and sales/product teams.

• Address escalated accounts and issues effectively.

• Oversee special projects and tasks as needed.

• Function as a patient advocate and enhance relationships among payers, healthcare providers, and patients.

• Facilitate access to therapies and support services.

• Manage a regional caseload efficiently.

• Gather and evaluate patient insurance benefit information.

• Assist physician office staff and patients in completing insurance forms and program applications.

• Monitor and follow up on prior authorization and appeal requests.

• Deliver exceptional customer service and resolve or escalate requests and complaints appropriately.

• Maintain regular phone communication with provider representatives, third-party customer service teams, and pharmacy personnel.

• Report reimbursement trends and delays to the supervisor.

• Process correspondence diligently.

• Provide necessary documentation to expedite prior authorization requests, including demographics, authorizations/referrals, NPI numbers, and referring physicians.

• Collaborate with inter-departmental associates.

• Engage with payors to ensure accurate and timely benefit investigations.

• Use judgment within standard operating procedures to determine the best course of action.

• Execute other related duties as assigned.

⛳️ Requirements

• Minimum of 3 years of experience in a physician’s office, healthcare environment, and/or insurance background is preferred.

• A Bachelor's Degree is preferred.

• Exceptional verbal and written communication skills are essential.

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

• Proficient keyboarding skills are required.

• Competent in MS Word and Excel.

• Knowledge of HIPAA regulations is necessary.

• Detail-oriented and highly organized.

• Strong interpersonal skills are a must.

• Understanding of pharmacy and medical benefits is advantageous.

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

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

• Strong problem-solving skills are required.

• Must be flexible with schedule and hours.

• Extensive travel is required (60% travel).

• Regular and reliable attendance is essential.

• Must document interactions in compliance with HIPAA regulations.

🏝️ Benefits

• Reasonable accommodations for individuals with disabilities.

• Equal employment opportunity and nondiscrimination protections.

• AI-supported recruiting and employment process with human review of final decisions.