Reimbursement Case Manager

🕒 3 dias atrás

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CareMetx, LLC

SiteLinkedInTodas as Vagas

501 - 1000 funcionários

⚕️ Seguro de Saúde

Healthcare Insurance

CareMetx, LLC é uma empresa especializada em transformar o acesso dos pacientes a terapias especiais, reduzindo o tempo para o início do tratamento. Eles oferecem um serviço de Hub digital que aborda barreiras emocionais, financeiras e clínicas para os pacientes, visando melhorar os prazos de tratamento e o uso contínuo das terapias. A CareMetx proporciona suporte de alta qualidade e utiliza tecnologia avançada para oferecer soluções de acesso, acessibilidade e adesão, beneficiando tanto os pacientes quanto os prestadores de serviços de saúde. Eles fazem parceria com marcas farmacêuticas especializadas, prestadores de serviços de saúde e sistemas hospitalares para melhorar os resultados dos pacientes.

Descrição

• 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 reviews 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.

🎯 Requisitos

• 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

🏖️ Benefícios

• Health insurance • 401(k) matching • Flexible work hours • Paid time off • Professional development opportunities