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.

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

Reimbursement Case Manager – Patient Access Services

Key skills