Reimbursement Case Manager

🔥 12 hours ago

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

CareMetx, LLC

WebsiteLinkedInAll Job Openings

501 - 1000 employees

💼 Consulting

🏥 Healthcare

⚕️ Healthcare Insurance

Consulting • Healthcare • 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

• Serve as a single point of contact and voice for providers and patients • Act as a patient advocate and enhance the caller/contact experience • Coordinate access to therapies, conduct follow-up, and facilitate access to support services • Manage caseload according to program parameters • Collect and review patient information as authorized by program SOPs • Validate required information and assist providers and patients • Guide physician office staff and patients through program applications • Determine patient eligibility and conduct patient enrollment activities, including patient assistance and copay assistance programs • Perform reimbursement activities including benefit investigations, prior authorizations, and appeals • Provide customer service and resolve or escalate requests and complaints • Maintain phone contact with patients, provider representatives, customer service representatives, and pharmacy staff • Provide reimbursement information to providers and patients • Report adverse events according to training and SOPs • Coordinate with inter-departmental associates • Document interactions in the CareMetx Connect system in compliance with HIPAA regulations • Maintain regular and reliable attendance • Perform 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 • 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 • Ability to sit regularly and occasionally lift or move up to 10 pounds

🏖️ Benefits

• CareMetx considers equivalent combinations of experience and education for most jobs • Equal employment opportunity employment practices • Reasonable accommodations for individuals with disabilities