Reimbursement Case Manager

🕒 Junho 30

🇺🇸 Estados Unidos – Remoto (EUA)

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

👔 Gerente

👻 Score fantasma 33%

O que significa: quão provável esta vaga está aberta sem contratação ativa.Como ler: 60% ou mais significa que achamos que é uma vaga fantasma. Pontuações mais baixas preocupam menos.Como pontuamos: tempo em aberto, republicações, vagas abertas vs tamanho do time, rapidez para fechar vagas, e se o salário está divulgado.Observação: é uma estimativa de dados públicos, não um julgamento da empresa. Vagas reais podem ter pontuação alta, então use como uma dica, não como um fato.

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CareMetx, LLC

SiteLinkedInTodas as Vagas

501 - 1000 funcionários

💼 Consultoria

🏥 Saúde

⚕️ Seguro de Saúde

Consulting • Healthcare • 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. • Provides 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. • Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly. • Maintains 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). • Coordinates with inter-departmental associates as necessary. • Work on problems of moderate scope where analysis of data requires a review of a variety of factors. • Exercises 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. • Maintains 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

• Flexible work arrangements • Professional development opportunities