Senior Case Manager, Reimbursement

🕒 vor 17 Tagen

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UBC

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1001 - 5000 Mitarbeiter

Gegründet 2003

🧬 Biotechnologie

⚕️ Krankenversicherung

💊 Pharmazie

Biotechnology • Healthcare Insurance • Pharmaceuticals

UBC ist ein Unternehmen, das sich der Verbesserung von Patientenergebnissen widmet, indem es spezielle Therapien mit bedürftigen Patienten verbindet. Sie bieten moderne und maßgeschneiderte Lösungen, die sich auf den Zugang, die Sicherheit und die Evidenzerzeugung für biopharmazeutische Produkte konzentrieren. UBC ist spezialisiert auf die Evidenzentwicklung, das Risikomanagement und den Patientenzugang und nutzt reale Daten und innovative Technologien, um die Gesundheitsreise zu optimieren und einen effektiven Medikamenteneinsatz zu gewährleisten.

Beschreibung

• Provide day-to-day oversight and coordination of caseload to ensure all case elements and tasks are completed timely and ensure cases move through the process as required. • Act as single point of contact responsible for prior authorization and appeal processing communications to patients, healthcare providers, field reimbursement representatives and other external stakeholders. • Serve as a patient advocate and resource for patients as they navigate through the reimbursement process while coordinating any additional patient access services within program guidelines. • Performs quality checks on cases and report trends to leadership. • Responsible for good housekeeping techniques, adhering to quality and production standards while complying with all applicable company, state and federal safety and environmental programs and procedures. • Troubleshoot complex cases, spanning multiple disease-states, while interfacing with key stakeholders (internal/external) to ensure optimal start to therapy. • Report Adverse Drug Events that have been experienced by the patient in accordance pharmaceutical requirements. • Recognize a product quality complaint and forward caller/written information to a manufacturer. • Act as point of contact for case managers to assist with prior authorization and appeal requirements, provide guidance, answer process questions and address escalated issues when appropriate. • Provides support for at-risk patients and prescribers to help mitigate any lapse in the start or continuation of therapy. • Collaborates with other senior case managers, managers and quality team on a monthly basis to review quality trends, creating process improvement initiatives for the next month. • Prepares and presents team huddles, and client presentations as deemed appropriate (minimum one presentation per month) • Other duties, as assigned.

🎯 Anforderungen

• 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 along with the ability to multi-task.

🏖️ Vorteile

• 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