Senior Reimbursement Case Manager

Role Overview

• Responsible for customer service and case management.
• Work interactively with patients, healthcare providers, specialty pharmacies, and manufacturer clients.
• Support various reimbursement functions including benefits investigations, prior authorization support and call triage.
• Respond to all patient, nursing, and provider account inquiries.
• Document all provider, payer, and client interactions into the CareMetx Connect system.
• Acts as a single point of contact and voice for all providers, patients and product/sales team.
• Handle escalated accounts and issues.
• Serve as a patient advocate and enhance the relationship between the payer, HCP and patient.
• Coordinate access to therapies and support services.
• Manage a regional case load.
• Provide assistance to complete and submit insurance forms and program applications.
• Track and follow up on prior authorization and appeal requests.
• Provide exceptional customer service to internal and external customers.
• Maintain frequent phone contact with provider representatives and pharmacy staff.
• Report any reimbursement trends/delays to the supervisor.
• Communicate effectively with payors to ensure accurate and timely benefit investigations.

Requirements

• Previous 3+ years of experience in a physician’s office, healthcare setting, and/or insurance background preferred.
• Bachelor’s Degree Preferred.
• 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
• Excellent interpersonal skills
• 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.

Benefits

• Extensive travel is required (60% travel)