Senior Case Manager, Reimbursement

Job Description:

• Provide day-to-day case management oversight and coordination of assigned caseload
• Ensure case elements and tasks are completed timely and cases move through the process as required
• Act as the single point of contact for prior authorization and appeal processing communications
• Serve as a patient advocate and resource throughout the reimbursement process
• Coordinate additional patient access services within program guidelines
• Perform quality checks on cases and report trends to leadership
• Troubleshoot complex cases spanning multiple disease states
• Interface with internal and external stakeholders to ensure optimal start to therapy
• Report Adverse Drug Events in accordance with pharmaceutical requirements
• Recognize product quality complaints and forward information to the manufacturer
• Assist case managers with prior authorization and appeal requirements, process questions, and escalations
• Support at-risk patients and prescribers to mitigate lapses in therapy
• Collaborate with senior case managers, managers, and the quality team on quality trends and process improvement initiatives
• Prepare and present team huddles and client presentations, with a minimum of one presentation per month
• Serve as an account manager for prescribers when assigned
• Share best practices and territory trends with client field teams
• Mentor and/or lead other case managers
• Manage work in progress to acceptable quality and productivity standards
• Perform other duties as assigned

Requirements:

• Bachelor’s degree or six years of relevant working experience
• Five (5) or more years of relevant experience in pharmacy benefit management, specialty pharmacy or patient support/access (HUB) services preferred
• Three (3) or more years of relevant experience in pharmacy and/or medical benefit verifications, prior authorization and/or appeals required
• Medical Assistant, Social Worker or Senior Reimbursement Specialist experience preferred
• Proficient in Microsoft Office applications
• Knowledge of medical and claims processing terminology
• Excellent written/verbal communication to include providing clear instructions
• Must possess a strong critical thinking skillset
• Ability to multi-task
• Experience with Pharmacy Benefit Management, complex reimbursement case management, and pharmacy reimbursement hubs
• Ability to work with patients, healthcare providers, field reimbursement representatives, prescribers, and other stakeholders
• Ability to comply with applicable company, state and federal safety and environmental programs and procedures

Benefits:

• Remote opportunities
• Competitive salaries
• Growth opportunities for promotion
• 401K with company match
• Tuition reimbursement
• Flexible work environment
• 20 Days PTO (Paid Time Off)
• Paid Holidays
• Employee assistance programs
• Medical, Dental, and vision coverage
• HSA/FSA
• Telemedicine (Virtual doctor appointments)
• Wellness program
• Adoption assistance
• Short term disability
• Long term disability
• Life insurance
• Discount programs