Senior Reimbursement Case Manager

🔥 15 minutes ago

🇺🇸 United States – Remote

💵 $21 - $24 / hour

⏰ Full Time

🟠 Senior

👔 Manager

👻 Ghost score 0%

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 for providers, patients, and product/sales teams • Handle escalated accounts and issues • Manage special projects and tasks • Serve as a patient advocate and strengthen payer, healthcare provider, and patient relationships • Coordinate access to therapies and 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 • Provide customer service and resolve or escalate requests and complaints • Maintain frequent 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 • Apply judgment within standard operating procedures to determine appropriate action • 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 • 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 • Must be flexible on schedule and hours • Extensive travel is required (60% travel) • Must maintain regular and reliable attendance • Must document interactions in compliance with HIPAA regulations

🏖️ Benefits

• Reasonable accommodations for individuals with disabilities • Equal employment opportunity and nondiscrimination protections • AI-supported recruiting and employment process with human review of final decisions