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CareMetx, LLC logo
CareMetx, LLC

Patient access at the speed of flight

Reimbursement Case Manager

ManagerManagerFull TimeRemoteSeniorTeam 501-1,000H1B No SponsorCompany SiteLinkedIn

Location

United States

Posted

29 days ago

Salary

0

Seniority

Senior

Bachelor Degree3 yrs expEnglish

Job Description

Reimbursement Case Manager

CareMetx, LLC

• 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 • Maintain regular and reliable attendance, including being present, on time, and prepared for work as scheduled • Performs other related duties as assigned

Job 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
  • 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
  • Customer satisfaction focused

Benefits

  • Must be flexible on schedule and hours
  • Overtime may be required from time to time
  • Must be willing to work weekends if required to meet company demands

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