Reimbursement Case Manager – Patient Access Services
UBC
full-time
Posted on:
Location Type: Remote
Location: United States
Visit company websiteExplore more
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.
- Communicate patient benefits and responsibility timely and accurately.
- Assess and refer patients appropriately for special programs/services when appropriate.
- Performs quality checks on cases and report trends to leadership.
- Responsible for good housekeeping techniques, adhering to quality and production standards while complying with all applicable company, state and federal safety and environmental programs and procedures.
- Troubleshoot complex cases, spanning multiple disease-states, while interfacing with key stakeholders (internal/external) to ensure optimal start to therapy
- Report Adverse Drug Events that have been experienced by the patient in accordance pharmaceutical requirements.
- Recognize a product quality complaint and forward caller/written information to a manufacturer.
- Other duties, as assigned.
Requirements
- Bachelor’s degree or six years of relevant working experience
- Two (2) or more years of relevant experience in pharmacy benefit management preferred
- 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
Benefits
- Remote opportunities
- Competitive salaries
- Growth opportunities for promotion
- 401k with company match*
- Tuition reimbursement
- Flexible work environment
- 20 Days PTO Annually (accrued)
- Paid Holidays
- Employee assistance programs
- Medical, Dental, and vision coverage
- HSA/FSA
- Telemedicine (Virtual doctor appointments)
- Wellness program
- Adoption assistance
- Short term disability
- Long term disability
- Life insurance
- Discount programs
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
pharmacy benefit managementmedical terminologyclaims processingquality checksadverse drug event reportingtroubleshooting complex casescase coordinationprior authorization processingappeal processing
Soft Skills
communicationinterpersonal skillsorganizational skillsattention to detailproblem-solvingleadershiptime managementcustomer service
Certifications
Bachelor's degreeMedical Assistant certificationSocial Worker certificationSenior Reimbursement Specialist certification