Reimbursement Case Manager

CareMetx, LLC

Reimbursement Case Manager at CareMetx managing client cases and providing customer service support. Engaging with patients, providers, and pharmacies to streamline reimbursement processes.

Posted 5/26/2026full-timeRemote • 🇺🇸 United StatesMid-LevelSeniorWebsite

About the role

Key responsibilities & impact

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

What you’ll need

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

Comp & perks

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

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

reimbursement activitiesbenefit investigationsprior authorizationspatient enrollmentpatient assistance programscopay assistanceknowledge of pharmacy benefitsknowledge of medical benefitsHIPAA regulationsdata analysis

Soft Skills

excellent verbal communicationexcellent written communicationmulti-taskingadaptabilityattention to detailhighly organizedexcellent interpersonal skillsproblem solvingcustomer satisfaction focusindependent work