Dallas, TX
Start a 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?
We are hiring for Reimbursement Case Managers
Location: WORK FROM HOME- FULLY REMOTE - EQUIPMENT PROVIDED
Candidates must reside in TX, AZ, IN, KY, NC, SC, GA, FL in order to be considered for this role
Pay: $20.00 - $23.00/hr (based on experience)
Schedule: 8 hour shift between 7am - 7pm CST / 8am - 8pm EST
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 preferred
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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