Hybrid Reimbursement Case Manager

at RareMed Solutions

• Job title: Reimbursement Case Manager
• Job type: Full Time
• Experience level: Junior, Mid level
• Salary: Not specified
• Degree requirement: High School Diploma
• Location requirements: Hybrid, Coraopolis, United States

About the role

• Reimbursement Case Manager responsible for managing patient claims and supporting pharmacy reimbursements. Serving as clients’ primary contact for inquiries and coordination of care.

Responsibilities

• 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