Launch Your Career with a Specialized Company That Plays a Key Role in Delivering Specialty Products and Devices to Patients

Position: Reimbursement Case Manager

Location: Remote (Work from Home) - Equipment Provided

Eligibility: Candidates must reside in TX, AZ, IN, KY, NC, SC, GA, or FL.

Compensation: $20.00 - $23.00 per hour (commensurate with experience)

Schedule: 8-hour shifts between 7 AM - 7 PM CST / 8 AM - 8 PM EST

Overview:

Join our team as a Reimbursement Case Manager under the general oversight of the operational program leadership. In this role, you will be responsible for managing customer service and case management tasks. You will collaborate with patients, healthcare providers, pharmacies, and manufacturer clients, supporting various reimbursement and patient assistance functions. This position involves responding to patient and provider inquiries and documenting all interactions in compliance with HIPAA regulations.

Primary Duties and Responsibilities:

• Serve as the primary contact and advocate for all providers and patients, demonstrating compassion and professionalism.

• Enhance the caller and contact experience by acting as a patient advocate.

• Coordinate access to therapies, conduct follow-ups, and facilitate access to necessary support services.

• Manage a case load based on program parameters.

• Collect and review patient information as authorized by program SOPs.

• Ensure completeness of required information and assist providers and patients.

• Guide physician office staff and patients in completing and submitting program applications in a timely manner.

• Determine patient eligibility and conduct enrollment activities for patient assistance programs and copay assistance.

• Perform reimbursement-related tasks such as benefit investigations, prior authorizations, and appeals.

• Provide exceptional customer service to internal and external customers; resolve customer requests promptly and accurately, escalating complaints as needed.

• Maintain regular phone contact with patients, provider representatives, third-party customer service representatives, and pharmacy staff.

• Provide reimbursement information to providers and patients.

• Report all Adverse Events (AEs) in accordance with training and Standard Operating Procedures (SOPs).

• Coordinate with other departments as needed.

• Address moderate scope problems, analyzing data and considering various factors.

• Exercise judgment within defined SOPs to determine the appropriate course of action.

• Typically receive minimal instruction for daily tasks and general guidance for new assignments.

• Possess extensive knowledge of HIPAA regulations and adhere to all company policies.

• Perform related duties as assigned.

Experience and Educational Requirements:

• At least 3 years of experience in a specialty pharmacy, medical insurance, reimbursement hub, physician s office, healthcare setting, or similar environment is preferred.

• Bachelor s Degree is preferred.

Minimum Skills, Knowledge, and Abilities:

• Excellent verbal and written communication skills.

• Ability to multi-task and adapt to shifting priorities.

• Proficient keyboard skills.

• Competent in MS Word and Excel.

• Knowledge of HIPAA regulations.

• Detail-oriented and highly organized.

• Understanding of pharmacy and medical benefits.

• Familiarity with commercial and government payers is preferred.

• Ability to work independently or as part of a team.

• Strong problem-solving skills.

• Focused on customer satisfaction.