Reimbursement Case Manager

Start a new CAREER with a niche company that is an essential player in getting specialty products and devices to patients who need them by managing reimbursements for those products, identifying alternative funding when insurers do not pay, and providing clinical services.

Are you ready to start your next opportunity?

JOB TITLE : Reimbursement Case Manager

Location : WORK FROM HOME- FULLY REMOTE - EQUIPMENT PROVIDED

Candidates must reside in Texas, Florida or North Carolina in order to be considered for this role

Pay : $20.00 - $23.00 / hr (based on experience)

Schedule : 8 hour shift Monday-Friday between 7am - 7pm CST / 8am - 8pm EST

JOB DESCRIPTION :

Under the general supervision of the operational program leadership, the Reimbursement Case Manager is responsible for customer service and case management.

The Reimbursement Case Manager will work interactively with patients, healthcare providers, pharmacies, and manufacturer clients.

The team will also support various reimbursement and patient assistance functions. The Reimbursement Case Manager responds to all patient, and provider account inquiries.

Documents all interactions into the client system in compliance with HIPAA regulations.

PRIMARY DUTIES AND RESPONSIBILITIES :

Acts as a single point of contact and voice for all providers and patients. Works as a patient advocate and always demonstrates compassion

Serves as a patient advocate and enhances the caller / contact experience

Coordinates access to therapies, conducts appropriate follow up and facilitates access to appropriate support services

Manages case load depending on the parameters of the program

Collects and review all patient information, to the degree authorized by the SOP of the program

Validates completeness of all required information and provides assistance to provider and / or patient

Provide guidance to physician office staff and patients on how to complete and submit all necessary program applications in a timely manner

Determines patient s eligibility and conducts patient enrollment activities (example patient assistance programs and copay assistance)

Performs reimbursement related activities such as benefit investigations, prior authorizations, appeals, etc.

Provide exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner;

escalates complaints accordingly

Maintain frequent phone contact with patients, provider representatives, third party customer service representatives and pharmacy staff

Provides reimbursement information to providers and / or patients

Reports all Adverse Events (AE) disclosed in alignment with training and Standard Operational Procedures (SOP)

Coordinate with inter-departmental associates as necessary

Work on problems of moderate scope where analysis of data requires a review of a variety of factors

Exercise judgment within defined standard operating procedures to determine appropriate action

Typically receives little instruction on day-to-day work, general instructions on new assignments

Extensive knowledge of HIPAA regulations and follows all company policies

Perform related duties as assigned

EXPERIENCE AND EDUCATIONAL REQUIREMENTS :

Previous 3+ years of experience in a specialty pharmacy, medical insurance, reimbursement hub experience, physician s office, healthcare setting, and / or insurance background required

Bachelor s Degree Preferred

MINIMUM SKILLS, KNOWLEDGE AND ABILITY REQUIREMENTS :

Excellent verbal and written communication skills

Ability to multi-task and adapt to changing priorities

Proficient keyboard skills

Competency in MS Word and Excel

Knowledge of HIPAA regulations

Detailed oriented and highly organized

Knowledge of pharmacy benefits, and medical benefits

Global understanding of commercial and government payers preferred

Ability and initiative to work independently or as a team member

Ability to problem solve

Customer satisfaction focused

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