RareMed Solutions

Reimbursement Case Manager

RareMed Solutions

full-time

Posted on:

Location Type: Hybrid

Location: Coraopolis • Pennsylvania • United States

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About the role

  • Serve as primary point of contact and case manager for client and customer inquiries and escalations
  • Process benefits investigations, benefits verifications, prior authorization submissions, and appeals as necessary to accelerate patient care access
  • Coordinates services with internal program operations and Program Management
  • Manage patient claims for prescription drug and medical benefits in relation to providing excellent specialty pharmacy care
  • Establish self as regional expert on payer trends, product access, and reporting reimbursement trends and/or delays
  • Work independently to complete assigned working accordance with Standard Operating Procedures and defined service levels
  • Use high-level problem-solving skills to research cases independently
  • Maintain frequent phone contact with internal operational staff, external client, and external specialty pharmacies
  • Provide exceptional, white glove, customer service to internal and external customers
  • Provide support to ensure efficient referral processing from referral intake to triaging of prescription
  • Independently and effectively resolve complex issues related to pharmacy reimbursement and patient support

Requirements

  • High school diploma or equivalent
  • 2+ years of relevant pharmacy reimbursement/insurance experience
  • 2+ years of relevant pharmacy case management experience
  • Working knowledge of BI/BV process, pharmacy and prescription benefits, prior authorization process, and pharmacy access support solutions
  • Ability to communicate in a clear, logical, effective, and consistent manner
  • Ability to independently manage case load, prioritize work, and use time management skills to manage deliverables
  • Empathy, drive, and commitment to exceptional service
  • Associate’s Degree or Bachelor’s Degree (preferred)
  • Understanding of plan types – Government, Commercial, Medicaid, VA, Fed
  • 1+ years experience as a pharmacy technician (preferred)
  • 1+ years experience operating in CareTend Pharmacy Management System (preferred)
  • Possess a strong understanding of biologic/specialty pharma market and patient access challenges (preferred)
  • Knowledge of insurance structure (ex PBM’s, major medical plans, co-pay assistance /cards) (preferred)
  • Working Knowledge of Third-Party and other Foundation programs (preferred)
  • Basic understanding of Co-Pay Assistance (if applicable) (preferred)
  • Strong analytical and organizational skills with attention to detail (preferred)
  • Excellent verbal and written communication skills (preferred)
  • Ability to proficiently use Microsoft Excel, Outlook and Word (preferred)
  • Knowledge of Rare Diseases (preferred)
  • Experience documenting requirements, creating training materials and working directly with end users (preferred)
  • Self-starter with ability to exercise sound independent judgment (preferred)
Benefits
  • hybrid work structure combining remote work and in-office requirements
  • exceptional customer service
Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
pharmacy reimbursementinsurance experiencecase managementbenefits investigationsprior authorizationpharmacy access supportbiologic/specialty pharma marketinsurance structureCo-Pay AssistanceThird-Party programs
Soft Skills
problem-solvingcustomer servicetime managementempathydrivecommitment to serviceanalytical skillsorganizational skillsattention to detailindependent judgment
Certifications
high school diplomaAssociate’s DegreeBachelor’s Degree