Case Manager – Reimbursement
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Job Description
Reimbursement Case Manager acting as a patient advocate in the pharmaceutical industry. Coordinating patient access to therapies and providing support services for specialty pharmaceuticals.
Responsibilities:
- Provide day-to-day oversight and coordination of caseload to ensure all case elements and tasks are completed timely and ensure cases move through the process as required
- Act as single point of contact responsible for prior authorization and appeal processing communications to patients, healthcare providers, field reimbursement representatives and other external stakeholders
- Communicate patient benefits and responsibility timely and accurately
- Assess and refer patients appropriately for special programs/services when appropriate
- Performs quality checks on cases and report trends to leadership
- Responsible for good housekeeping techniques, adhering to quality and production standards while complying with all applicable company, state and federal safety and environmental programs and procedures
- Troubleshoot complex cases, spanning multiple disease-states, while interfacing with key stakeholders (internal/external) to ensure optimal start to therapy
- Report Adverse Drug Events that have been experienced by the patient in accordance pharmaceutical requirements
- Recognize a product quality complaint and forward caller/written information to a manufacturer.
- Other duties, as assigned.
Requirements:
- Bachelor’s degree or six years of relevant working experience
- Two (2) or more years of relevant experience in pharmacy benefit management preferred
- Medical Assistant, Social Worker or Senior Reimbursement Specialist experience preferred
- Proficient in Microsoft Office applications
- Knowledge of medical and claims processing terminology
- Excellent written/verbal communication to include providing clear instructions
Benefits:
- Remote opportunities
- Competitive salaries
- Growth opportunities for promotion
- 401k with company match*
- Tuition reimbursement
- Flexible work environment
- 20 Days PTO Annually (accrued)
- Paid Holidays
- Employee assistance programs
- Medical, Dental, and vision coverage
- HSA/FSA
- Telemedicine (Virtual doctor appointments)
- Wellness program
- Adoption assistance
- Short term disability
- Long term disability
- Life insurance
- Discount programs
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