Senior Case Manager, Reimbursement
UBC
full-time
Posted on:
Location: 🇺🇸 United States
Visit company websiteJob Level
Senior
About the role
- Provide day-to-day case management oversight and coordination of assigned caseload to ensure timely task completion
- Act as primary resource and single point of contact for patients, healthcare providers, field reimbursement representatives, and other stakeholders regarding prior authorizations, reauthorizations, and appeals
- Serve as a patient advocate and coordinate additional patient access services within program guidelines
- Perform quality checks on cases, report trends to leadership, and collaborate on process improvement initiatives
- Troubleshoot complex cases across multiple disease-states and interface with internal/external stakeholders to ensure optimal start to therapy
- Report Adverse Drug Events and forward product quality complaints to manufacturer as required
- Act as point of contact and mentor for case managers, provide guidance on prior authorization and appeal requirements, and handle escalations
- Prepare and present team huddles and client presentations (minimum one presentation per month)
- Serve in a lead capacity to manage work in progress, mentor staff, and ensure operations run smoothly
- Responsible for good housekeeping techniques, adhering to quality and production standards, and complying with company, state and federal programs and procedures
Requirements
- Bachelor’s degree or six years of relevant working experience
- Five (5) or more years of relevant experience in pharmacy benefit management, specialty pharmacy or patient support/access (HUB) services preferred
- Three (3) or more years of relevant experience in pharmacy and/or medical benefit verifications, prior authorization and/or appeals required
- Medical Assistant, Social Worker or Senior Reimbursement Specialist experience preferred
- Proficient in Microsoft Office applications
- Knowledge of medical and claims processing terminology
- Excellent written/verbal communication to include providing clear instructions
- Must possess a strong critical thinking skillset along with the ability to multi-task
- Experience working with Pharmacy Benefit Management, complex reimbursement case management, and providing customer service to patients