Reimbursement Case Manager

Purpose:

The Reimbursement Case Manager is a professional client facing role responsible for various functions, including accurate and timely response to client inquiries regarding specific referral status or escalation. The Reimbursement Case Manager serves as a p rimary point of contact for professional, concise internal and external communication regarding case status updates, next steps in prescription processing, communication of reimbursement issues, etc. The Reimbursement Case Managers will interact directly with external clients such as manufacturers and specialty pharmacies as well as internal teams including Operations and Program Management.

Responsibilities:

• Primary point of contact and case manager for client and customer inquiries and escalations. Coordinates services with internal program operations and Program Management
• Work independently to complete assigned work in accordance with Standard Operating Procedures and defined service levels to complete program enrollment, answer inquiries, and coordinate access to therapies
• Processing of patient and prescriber requests in order to ensure access to therapy in a timely manner
• Use high-level problem-solving skills to research cases independently , using professional judgement to make sound decisions
• Maintain frequent phone contact with internal operational staff, external client, and external specialty pharmacies
• Provides exceptional, white glove, customer service to internal and external customers; resolves any customer and client requests in a timely and accurate manner; escalates appropriately
• Provides support to ensure efficient referral processing from referral intake to triaging of prescription
• Independently and effectively resolves complex issues with creativity and innovation
• Application of defined business rules to qualify patients for manufacturer supported programs
• Ability to coordinate and collaborate with manufacturer representatives, HCP offices and other key personnel on complex cases which require strategic intervention
• Strong compliance mindset, demonstrating clear understanding of patient privacy laws
• Active participation in building and maintaining respectful, collaborative internal/external team relationships, exercising and encouraging positivity.
• Establish self as regional expert on payer trends , product access , and reporting reimbursement trends and/or delays ( i.e. denials, underpayment, access delays, etc.)
  
  
  

Required Qualifications:

• College degree ( bachelors or associate degree)
• Previous 2 yea rs of experience in a pharmacy , healthcare setting, and/or insurance background ; customer service focus
• Advanced knowledge and experience in healthcare setting
• Ability to communicate effectively both orally and in writing with a focus on customer satisfaction
• Ability to independently manage case load, prioritize work, and us time management skills to manage deliverables
• Empathy, drive and commitment to exceptional service
• Strong analytical and organizational skills with attention to detail
• Ability to work flex schedule per Program business need s
• Possess effective oral and written communication skills
• Possess a strong understanding of biologic/specialty pharma market and patient access challenges
• Ability to leverage professional expertise and apply company policies and procedures to resolve challenges
  
  
  

Preferred Qualifications:

• Ability to build productive internal/external working relationships
• Experience with benefit investigation and benefit verification of prescription be n e fits
• Strong interpersonal skills
• Ability to proficiently use Microsoft Excel, Outlook and Word
• Certified Pharmacy Technician or Case Management Experience
• Working Knowledge of Third-Party and other Foundation programs
• Basic understanding of Co-Pay Assistance (if applicable)
  
  
  

Work Environment

This job operates in a professional office environment and teleworking from the employee’s home address listed in their employment file. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines. When telecommuting employees must have reliable internet access in order to access required systems and software associated with the position's responsibilities. The amount of time the employee is expected to work per day or pay period will not change as a result of participation in the teleworking program. Employees are responsible for the set-up of their home office environment, including physical set-up, internet connection, phone line, electricity, good lighting, comfortable temperature, furniture, etc. Employee’s teleworking space should be separate and distinct from their “home space” and allow for privacy. RareMed expects employees teleworking to be as efficient and professional as if they were in the office. The amount of time spent in office or teleworking is contingent upon the needs/priorities of RareMed and will vary based on those needs/priorities.

Physical Demands

While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand; walk; use hands and fingers, handle or feel; and reach with hands and arms.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function of the job.