Senior Case Manager, Reimbursement
UBC
full-time
Posted on:
Location: 🇺🇸 United States
Visit company websiteJob Level
Senior
About the role
- Provide day-to-day oversight and coordination of caseload to ensure all case elements and tasks are completed timely and ensure cases move through the process as required
- Act as single point of contact responsible for prior authorization and appeal processing communications to patients, healthcare providers, field reimbursement representatives and other external stakeholders
- Serve as a patient advocate and resource for patients as they navigate through the reimbursement process while coordinating any additional patient access services within program guidelines
- Perform quality checks on cases and report trends to leadership
- Troubleshoot complex cases, spanning multiple disease-states, while interfacing with key stakeholders (internal/external) to ensure optimal start to therapy
- Report Adverse Drug Events and recognize product quality complaints per pharmaceutical requirements
- Act as point of contact for case managers to assist with prior authorization and appeal requirements and address escalations
- Provide support for at-risk patients and prescribers to mitigate lapses in therapy
- Collaborate on quality trends and process improvements; prepare and present team huddles and client presentations
- Serve as mentor/lead to ensure operations run smoothly and manage work in progress to standards
- Other duties, as assigned
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
- Strong critical thinking skillset and ability to multi-task