Reimbursement Case Manager

🕒 3 days ago

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CareMetx, LLC

WebsiteLinkedInAll Job Openings

501 - 1000 employees

⚕️ Healthcare Insurance

Healthcare Insurance

CareMetx, LLC is a company that specializes in transforming patient access to specialty therapeutics by reducing the time to therapy. They offer a digital Hub service that addresses emotional, financial, and clinical barriers for patients, aiming to improve treatment timelines and ongoing therapy use. CareMetx provides high-touch support and utilizes advanced technology to offer solutions for access, affordability, and adherence, benefiting both patients and healthcare providers. They partner with specialty pharmaceutical brands, healthcare providers, and hospital systems to enhance patient outcomes.

📋 Description

• 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

🎯 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