PRO-spectus

Title: Case Manager - Patient Services - Healthcare Location: US - Remote Job Description: The Case Manager is a professional external-facing role, which is responsible for oversight of cases throughout the authorization/approval journey for patients and their providers. This role relies on critical thinking skills to drive cases through complex communication, authorization, and appeal processes, with the primary focus of expediting patients’ access to care while securing payment channels to avoid unexpected out of pocket cost. This may involve interacting with private commercial or government-run insurers, healthcare providers, suppliers/distributors, and patients to ensure access across the care continuum. Core Duties/Responsibilities: - Act as a single point of contact between the internal team, client, providers, payor, facility, and patient as needed. - Support cases through approval/denial process with a sense of urgency while maintaining accuracy. - Collaborate and provide direction to the internal and external stakeholders (i.e., Payor Specialist Team, Reimbursement Team, Clinical Team, client sales/MSL) and coordinate efforts to ensure accuracy and completeness of each case. - Identify and share trends impacting business processes with management. - Prioritize and act on key client activities and follow up with customers to ensure problems are solved. - Manage through ambiguity while designing innovative client and payor solutions. - Make sound independent decisions in urgent and non- routine situations pertaining to client and patient scenarios. - Interpret complex clinical documentation to prepare authorization documentation for payor submission in relation to medical policy criteria for coverage. - Partner with the interdisciplinary team to champion their clients, patients, and customers, and is responsible for the life cycle of their case to ensure successful completion. - Provide resources to patients, caregivers, health care providers and clients with resources available for financial assistance and transportation. - Provide compassionate and empathetic support to patients and caregivers. Skills / Requirements: - Maintains open, effective dialogue with effective communication and is both clear and thorough in reports, documentation, and other written communications. - High level of ability to coordinate multiple priorities and activities to accomplish goals. - Ability to independently manage case load, prioritize work, and use time management skills to manage deliverables. - Critical thinking and strong problem solving - Suggests creative ideas and innovative solutions while exploring multiple alternatives and approaches to overcome obstacles and find solutions. - Excellent follow-through with solid levels of determination and tenacity. - Remains calm and productive during transitions or changing circumstances. - Demonstrates composure and professionalism under difficult circumstances. - Ability to communicate effectively both orally and in writing with a focus on customer satisfaction, with empathy, drive, and commitment to exceptional service. - Possess a strong understanding of the US Healthcare System, public and private payer nuances, and patient access challenges for new to market, high dollar or highly complex medical interventions, products, therapies. - Ability to leverage professional expertise and apply company policies and procedures to resolve challenges. - Ability to develop, maintain and navigate relationships. - Ability to interpret and understand medical documentation as it relates to each specific case and how it applies to a specific medical policy. - Ability to be agile and adaptable in responses to rapidly changing processes and consumer needs. Education, Certifications and Experience: - College Degree is preferred (Bachelor's or Associate Degree). - 4 – 6 years of experience in a healthcare setting and/or medical insurance background with a customer service focus. - Experience with maintaining detailed records of client interactions, services provided, and progress made. - Experience working in office, hospital/clinic or home health care settings welcome. - Experience in developing and/or implementing new technologies a plus. - Experience with complex medical products and associated insurance processes a plus. - Experience writing Appeals is preferred. Physical Requirements: - As a remote-forward organization, this position operates in a professional office environment and teleworking from the employee’s home address listed in their employment file. - Prolonged periods of sitting at a desk and working on a computer. - Keyboarding - Speaking - Must be able to lift up to 15 pounds at times. - Working hours to support activities in multiple time zones. Our PRO-spectus Culture Philosophy At PRO-spectus we have created a culture that is supportive, dedicated, and teamwork driven. We celebrate each other’s joys in personal life and professional accomplishments, promoting meaningful relationships and friendships. Our employees bring strength of mind and spirit to make the extraordinary happen every day. With humility and compassion at our core, PRO-spectus is proud of our relentless focus towards the higher purpose of improving the lives of patients we support. We recognize it takes a lot of people working together with a common goal to make spectacular happen, and we never forget that at the heart of our company are the people who make it work. PRO-spectus is an Equal Opportunity / Affirmative Action employer. All qualified individuals will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, ancestry, age, disability, protected veteran status, marital status or other protected status under federal, state or local laws. At PRO-spectus, we are deeply committed to pay transparency and equity. The hourly range for this position is $40.00 - $54.00 per hr based on experience and qualifications, with the final offer reflecting skills and other job-related factors. Beyond competitive pay, we offer a comprehensive and generous benefits package designed to support your well-being and work-life balance. Our benefits include robust medical, dental, and vision plans; life insurance and disability coverage; and tax-advantaged savings accounts. We also provide an Employee Assistance Program, home office benefits, and unique perks like an Employee Ownership Program. With paid time off, holidays, bereavement leave, and a 401(k)-retirement plan with employer matching, PRO-spectus prioritizes your financial and personal security. Plus, you may be eligible for a performance-based bonus opportunity. Join PRO-spectus, where your career growth, well-being, and contributions truly matter!

Title: Reimbursement Specialist - Healthcare Location: US - Remote Job Description: We’re always looking for talented, passionate individuals to join our team! This posting is part of our ongoing search for exceptional candidates. We maintain a pipeline of qualified candidates for current and future openings. By applying, you’ll be considered for opportunities that align with your skills and experience. If you’re driven, collaborative, and ready to make an impact, we encourage you to submit your application today to be part of our talent community. The Reimbursement Specialist II ensures that healthcare providers and organizations are appropriately reimbursed for their services. They are responsible for verifying insurance coverage, submitting reimbursement claims, and communicating with insurance companies, patients, and healthcare providers. In addition, they must stay up to date with changes in insurance policies and regulations that may affect reimbursement procedures. Core Duties/Responsibilities: - Ensure timely collection of outstanding Accounts Receivable and resolution of billing/claims issues. - Research, evaluate, and interpret complex information relative to appeals, payor specific billing policies, and guidelines related to insurance. - Manage assigned accounts to ensure timely and appropriate actions are taken to ensure positive cash flow. - Required to stay up to date with changes in insurance policies and regulations that may affect reimbursement procedures which include commercial, Medicare, Medicaid and Workers Comp payers. - Identify any payments not made in accordance with contracted rates and fee schedules and properly escalate the incorrect payment to the payer. - Cross train to provide department coverage. - Varying clerical and light accounting work. - Additional duties may include data entry, record keeping, participating in projects, and other administrative support as needed. Skills / Requirements - Extensive experience with appeals, payor specific billing policies, and guidelines related to insurance and collection follow-up. - In-depth understanding of healthcare billing and coding processes. - Ability to understand and navigate complicated insurance policies and regulations. - Excellent written and verbal communication skills throughout a variety of stakeholders, including insurers, patients, and healthcare providers. - Strong organizational skills, attention to detail, and effective task management while responding productively to changing priorities. - Remains calm and objective in emotional or stressful situations. - Learns quickly and applies innovative methods, tools, and technology to the role. - High level of self-accountability for compliance with policies, procedures, and work requirements. - Seeks advice when unsure about choosing a course of action. - Makes solid routine decisions with coaching from others. - Learns about the key drivers of the organization’s business and uses those learns in the day-to-day work. - Maintains tenacity and work focus despite obstacles or setbacks and is comfortable dealing with first- time or unusual challenges. Education, Certifications and Experience: - Experience with payors and Clinical Guidelines or Medical Policy is preferred.  - Conversant with medical and billing terminology. - Expertise and knowledge of third-party payor. - Computer and database management skills to efficiently and effectively manage proprietary electronic systems. - Interpersonal and communication skills to effectively deal with a variety of people, including physicians, hospital leaders, nursing staff, patients, and family members. - High School Diploma with 5+ years’ healthcare experience or an Associate's Degree in a healthcare-related field with 3+ years’ experience. Physical Requirements: - As a remote-forward organization, this position operates in a professional office environment and teleworking from the employee’s home address listed in their employment file. - Prolonged periods of sitting at a desk and working on a computer - Keyboarding - Speaking - Must be able to lift up to 15 pounds at times. - Flexibility of working hours to support activities across multiple Time Zones. Our PRO-spectus Culture Philosophy At PRO-spectus we have created a culture that is supportive, dedicated, and teamwork driven. We celebrate each other’s joys in personal life and professional accomplishments, promoting meaningful relationships and friendships. Our employees bring strength of mind and spirit to make the extraordinary happen every day. With humility and compassion at our core, PRO-spectus is proud of our relentless focus towards the higher purpose of improving the lives of patients we support. We recognize it takes a lot of people working together with a common goal to make spectacular happen, and we never forget that at the heart of our company are the people who make it work. PRO-spectus is an Equal Opportunity / Affirmative Action employer. All qualified individuals will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, ancestry, age, disability, protected veteran status, marital status or other protected status under federal, state or local laws. At PRO-spectus, we are deeply committed to pay transparency and equity. The salary range for this position is $32.00 - $35.00 an hour, based on experience and qualifications, with the final offer reflecting skills and other job-related factors. Beyond competitive pay, we offer a comprehensive and generous benefits package designed to support your well-being and work-life balance.

Title: Sr. Director, Patient Services - Client Program Strategy - Healthcare Location: US - Remote Job Description: The Senior Director, Patient Services is responsible for providing strategic, operational, and people leadership for PRO-spectus Patient Services programs and capabilities. This role leads the design, execution, governance, and continuous optimization of patient-centered service models across the reimbursement and access lifecycle, including benefits investigation, prior authorization support, appeals support, affordability resources, patient assistance, case management, adherence Ssupport, and ongoing patient/provider engagement. As a senior leader within Patient Services, this role partners closely with the Head of Patient Services and cross-functional executive stakeholders to shape scalable operating models, strengthen client partnerships, advance operational excellence, and ensure compliant, high-quality delivery across multiple programs and teams. The Senior Director serves as a strategic advisor to clients and internal leadership, translating business objectives, patient needs, market access dynamics, and contractual commitments into effective program design, performance expectations, staffing strategies, technology enablement, and measurable outcomes. This role is accountable for leading through managers and senior operational leaders, building organizational capability, improving program performance, supporting growth, and fostering a collaborative, accountable, and high-performing culture aligned with PRO-spectus’ mission to help patients access the care they need. Core Duties/Responsibilities: - Provides senior strategic and operational leadership for Patient Services programs and capabilities, ensuring alignment with PRO-spectus business objectives, client expectations, patient needs, compliance requirements, and service excellence standards. - Leads a portfolio of complex Patient Services programs and/or functional capabilities, including reimbursement support, benefits investigation, prior authorization support, appeals navigation, affordability resources, patient assistance programs, case management, adherence support, and patient/provider engagement. - Partners with the Head of Patient Services to define function-level priorities, operating models, governance routines, staffing strategies, performance expectations, and scalable service delivery approaches. - Serves as a senior client-facing leader, building trusted relationships with client stakeholders and participating in strategic planning, business reviews, performance discussions, issue resolution, escalation management, and growth-related conversations. - Translates client strategy, product needs, therapy complexity, and access challenges into executable program designs, workflows, policies, SOPs, reporting frameworks, quality standards, training approaches, and staffing models. - Ensures assigned programs and teams meet or exceed service level commitments, contractual obligations, regulatory requirements, quality expectations, audit readiness standards, and internal performance goals. - Establishes, monitors, and evaluates key performance indicators across operational, quality, compliance, patient access, client satisfaction, employee engagement, productivity, and financial performance dimensions. - Uses data, trend analysis, root cause evaluation, and performance insights to identify risks, opportunities, and improvement priorities; drives action plans that produce measurable improvement across programs and teams. - Oversees program governance, including performance routines, escalation pathways, issue management, risk mitigation, CAPA support, policy adherence, audit readiness, and continuous improvement planning. - Provides leadership for new program implementations, transitions, expansions, and service model enhancements, including launch readiness, workflow design, technology configuration, staffing, training, reporting, and go-live support. - Leads or sponsors cross-functional initiatives that improve operational scalability, patient/provider experience, quality, compliance, automation, reporting, technology utilization, and team effectiveness. - Partners with Quality, Training, Workforce Management, Technology, Compliance, Human Resources, Finance, Client Services, Market Access, Revenue Cycle Management, Pharmacy, and Clinical Adherence teams to optimize resources and strengthen end-to-end service delivery. - Maintains strong operational command of staffing, capacity, productivity, utilization, and resource planning; ensures leadership teams are proactively adjusting plans to support program volumes, client commitments, and business priorities. - Supports budget planning, staffing forecasts, financial performance reviews, cost management, and resource allocation in partnership with leadership and Finance. - Provides strategic oversight of policies, procedures, SOPs, work instructions, training materials, quality monitoring processes, client-specific requirements, privacy expectations, pharmacovigilance/product complaint reporting, and other applicable compliance standards. - Acts as a senior escalation point for complex operational, client, compliance, patient access, staffing, technology, or performance issues, ensuring timely resolution and clear communication with stakeholders. - Coaches, develops, and manages directors, managers, supervisors, and/or senior individual contributors; strengthens leadership capability, succession readiness, employee engagement, and accountability across the Patient Services organization. - Builds and sustains a high-performing remote leadership culture grounded in collaboration, trust, transparency, patient-centered decision-making, operational discipline, and continuous improvement. - Identifies emerging reimbursement, payer, specialty pharmacy, market access, healthcare technology, and patient support trends; applies insights to improve service models, client strategy, and operational readiness. - Prepares and presents program performance, business objectives, risks, recommendations, strategic plans, and improvement initiatives to internal and external senior stakeholders. - Supports business growth by contributing operational expertise to client expansion discussions, solution design, implementation planning, and differentiated service offerings. - Performs other duties as assigned. Skills & Requirements: - Deep understanding of the reimbursement lifecycle, payer landscape, benefits investigation, prior authorization, appeals, medical policy, affordability programs, patient assistance programs, specialty pharmacy dynamics, market access, and patient support industry trends. - Proven ability to lead complex Patient Services, HUB, reimbursement, case management, specialty pharmacy, healthcare operations, or access support programs at scale. - Demonstrated strategic leadership capability, including experience translating business and client objectives into operating models, performance standards, staffing strategies, and measurable outcomes. - Strong client-facing executive presence, with the ability to build trusted relationships, communicate performance and risk, lead strategic business reviews, manage escalations, and influence senior stakeholders. - Excellent analytical, organizational, communication, presentation, and problem-solving skills. - Demonstrated ability to use data, reporting, dashboards, financial indicators, operational metrics, and quality insights to make decisions and drive continuous improvement. - Strong leader-of-leaders capability, including experience coaching managers, developing leadership talent, managing performance, supporting succession planning, and building engaged teams. - Ability to lead remote, distributed teams across multiple time zones while fostering accountability, collaboration, employee engagement, and consistent execution. - Experience overseeing program implementations, transitions, expansions, process redesign, workflow optimization, technology enablement, and change management. - Proficiency using CRM, healthcare management, case management, contact center, workforce management, reporting, quality monitoring, and other relevant technology platforms. - Strong understanding of operational quality, SOP governance, training compliance, audit readiness, CAPAs, risk management, and continuous improvement practices. - Customer-focused and patient-centered mindset with a commitment to improving access, affordability, and the end-user experience. - Ability to balance strategic priorities with operational urgency, manage ambiguity, adapt to changing client and program needs, and operate effectively in a fast-paced environment. - Dedication to maintaining confidentiality, ethical standards, compliance expectations, and professional integrity. Education, Certifications and Experience: - Bachelor’s degree or equivalent experience in a related field required. - Advanced degree in healthcare administration, business, life sciences, public health, nursing, pharmacy, or related field preferred. - 10+ years of progressive experience in healthcare, patient services, HUB operations, reimbursement support, specialty pharmacy, market access, case management, pharmaceutical services, healthcare services, or a related environment. - 7+ years of people leadership experience, including experience leading managers, supervisors, leaders of teams, or multi-program operations. - Experience leading client-facing healthcare programs, patient support services, reimbursement operations, access programs, specialty product support programs, or enterprise-level service delivery strongly preferred. - Experience with strategic program design, new program implementations, program transitions, client business reviews, audits, CAPAs, quality monitoring, workforce planning, budget support, and continuous improvement initiatives preferred. - Experience supporting rare disease, specialty, biologic, injectable, infused, cell and gene therapy, drug/device, or other high-touch therapies preferred. - Experience supporting business growth, client expansion, solution design, or service model development preferred. Physical Requirements: - As a remote-forward organization, this position operates in a professional office environment and teleworking from the employee’s home address listed in their employment file. - Prolonged periods of sitting at a desk and working on a computer. - Keyboarding - Speaking - Must be able to lift up to 15 pounds at times. - Working hours to support activities in multiple time zones. Our PRO-spectus Culture Philosophy At PRO-spectus we have created a culture that is supportive, dedicated, and teamwork driven. We celebrate each other’s joys in personal life and professional accomplishments, promoting meaningful relationships and friendships. Our employees bring strength of mind and spirit to make the extraordinary happen every day. With humility and compassion at our core, PRO-spectus is proud of our relentless focus towards the higher purpose of improving the lives of patients we support. We recognize it takes a lot of people working together with a common goal to make spectacular happen, and we never forget that at the heart of our company are the people who make it work. PRO-spectus is an Equal Opportunity / Affirmative Action employer. All qualified individuals will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, ancestry, age, disability, protected veteran status, marital status or other protected status under federal, state or local laws. At PRO-spectus, we are deeply committed to pay transparency and equity. The annual range for this position is $160,000 - 175,000 yearly based on experience and qualifications, with the final offer reflecting skills and other job-related factors. Beyond competitive pay, we offer a comprehensive and generous benefits package designed to support your well-being and work-life balance. Our benefits include robust medical, dental, and vision plans; life insurance and disability coverage; and tax-advantaged savings accounts. We also provide an Employee Assistance Program, home office benefits, and unique perks like an Employee Ownership Program. With paid time off, holidays, bereavement leave, and a 401(k)-retirement plan with employer matching, PRO-spectus prioritizes your financial and personal security. Plus, you may be eligible for a performance-based bonus opportunity.

• Act as a single point of contact between the internal team, client, provider, payor, facility, and patient as needed • Support cases through approval/denial process with a sense of urgency while maintaining accuracy • Provide direction to the aligned Payor Specialist Team and coordinate efforts to ensure accuracy and completeness of each case • Identify and share trends impacting business processes with management • Prioritize and act on key client activities and follow up with customers to ensure problems are solved • Manage through ambiguity while designing innovative client and payor solutions • Make sound independent decisions in urgent and non- routine situations pertaining to client and patient scenarios • Interpret complex clinical documentation to prepare authorization documentation for payor submission in relation to medical policy criteria for coverage • Partner with the interdisciplinary team to champion their clients, patients and customers and is responsible for the life cycle of their case to ensure successful completion • Provide resources to patients, caregivers, health care providers and clients with resources available for financial assistance and transportation • Provide compassionate and empathetic support to patients and care givers with life-threatening diagnoses • Coordinate with various service providers and healthcare professionals to ensure patients receive the appropriate support before and after surgery