Senior Reimbursement Case Manager

🔥 0 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟠 Senior

👔 Manager

👻 Ghost score 10%

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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

• Provide customer service and case management under the supervision of the Supervisor and Director • Interact with patients, healthcare providers, specialty pharmacies, and manufacturer clients • Support benefits investigations, prior authorization support, and call triage • Respond to patient, nursing, and provider account inquiries • Document provider, payer, and client interactions in the CareMetx Connect system in compliance with HIPAA regulations • Act as a single point of contact for providers, patients, and product/sales teams • Handle escalated accounts and issues • Manage special projects and tasks • Serve as a patient advocate and enhance collaboration among payers, healthcare providers, and patients • Coordinate access to therapies and facilitate access to support services • Manage a regional caseload • Collect and review patient insurance benefit information • Assist physician office staff and patients with insurance forms and program applications • Track and follow up on prior authorization and appeal requests • Resolve customer requests and escalate complaints • Maintain phone contact with provider representatives, third-party customer service representatives, and pharmacy staff • Report reimbursement trends and delays to the supervisor • Process correspondence • Provide documentation to expedite prior authorization requests, including demographics, authorizations/referrals, NPI numbers, and referring physicians • Coordinate with inter-departmental associates • Communicate with payors to ensure accurate and timely benefit investigations • Exercise judgment within standard operating procedures and perform other related duties as assigned

🎯 Requirements

• Previous 3+ years of experience in a 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 and HIPAA compliance • 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 • Flexible schedule and hours • Extensive travel required (60% travel)

🏖️ Benefits

• Equivalent combinations of experience and education considered • Reasonable accommodations for individuals with disabilities • Equal employment opportunity