Case Manager – Healthcare Appeals, Patient Access Advocate

🔥 29 minutes ago

🇺🇸 United States – Remote

💵 $40 - $54 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 Ghost score 0%

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PRO-spectus

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2008

🏥 Healthcare

💊 Pharmaceuticals

💼 Consulting

💰 Private equity on 2024-05

Healthcare • Pharmaceuticals • Consulting

PRO-spectus is a patient access and market access services provider that helps pharmaceutical, biotech, medical device, and diagnostic manufacturers overcome reimbursement, coding, and policy barriers to getting products to patients. The firm offers patient support services, reimbursement support, policy strategy, affordability and adherence programs, and leverages technology alongside market-access expertise to optimize access across the healthcare landscape. PRO-spectus positions itself as a collaborative, B2B partner to manufacturers seeking to expand coverage and patient access to specialized therapies and diagnostics.

📋 Description

• Act as the primary point of contact between internal teams, clients, providers, payors, facilities, and patients • Support cases through approval and denial processes with urgency and accuracy • Coordinate internal and external stakeholders to ensure case accuracy and completeness • Identify and share business-process trends with management • Prioritize client activities and follow up with customers to resolve problems • Develop innovative client and payor solutions amid ambiguity • Make independent decisions in urgent and non-routine client and patient situations • Interpret complex clinical documentation and prepare authorization documentation for payor submission • Partner with interdisciplinary teams throughout the case lifecycle to ensure successful completion • Provide patients, caregivers, providers, and clients with financial-assistance and transportation resources • Provide compassionate and empathetic support to patients and caregivers

🎯 Requirements

• 4–6 years of experience in a healthcare setting and/or medical insurance background with a customer service focus • Experience maintaining detailed records of client interactions, services provided, and progress made • Experience working in office, hospital/clinic, or home health care settings welcome • Experience developing and/or implementing new technologies a plus • Experience with complex medical products and associated insurance processes a plus • Experience writing appeals preferred • Strong understanding of the US Healthcare System, public and private payer nuances, and patient access challenges • Ability to interpret and understand medical documentation and apply it to specific medical policy criteria • Ability to coordinate multiple priorities and activities • Ability to independently manage caseload, prioritize work, and use time management skills • Critical thinking and strong problem-solving skills • Effective oral and written communication skills • Ability to develop, maintain, and navigate relationships • Ability to adapt to rapidly changing processes and consumer needs • Ability to work hours supporting activities across multiple time zones • College degree (Bachelor's or Associate Degree) preferred, not required

🏖️ Benefits

• Comprehensive medical, dental, and vision plans • Life insurance and disability coverage • Tax-advantaged savings accounts • Employee Assistance Program • Home office benefits • Employee Ownership Program • Paid time off • Paid holidays • Bereavement leave • 401(k) retirement plan with employer matching • Performance-based bonus opportunity • Supportive, dedicated, and teamwork-driven culture • Career growth opportunities

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