Reimbursement Case Manager

Reimbursement Case Manager

• Will serve as an expert on reimbursement issues and be responsible for handling the day-to-day activities within reimbursement services (benefits investigation, prior authorizations and appeals support)
• Complete medical and/or pharmacy benefit investigations, identify and facilitate submission of required documentation for payer/plan review for prior authorization, step edit identification and appeals according to program standard operating procedures.
• Knowledge and understanding of the different types of major payers including private/commercial and government (Medicare, Medicaid, VA, DoD)
• Maintains records in accordance with applicable standards and regulations to the programs/promotions
• Responsible to determine coverage availability and coordinate the financial aspects of healthcare services to ensure patients have access to prescribed therapy
• Follow program guidelines and escalate complex cases according to program policy and procedures
• As a program’s “eyes and ears”, works with the Franchise Program Manager, and Client on a day-to-day basis to maintain open lines of communication and share awareness regarding therapy access restrictions, policy changes and other changes in the reimbursement landscape
• Understand health and disease states of patients of the programs/promotions
• Maintains a high level of ethical conduct regarding confidentiality and privacy
• Incumbent may be asked to perform related job duties that are not specifically set-forth in this job description.

Skills

reimbursement, insurance, medical, insurance verification, prior-authorization, benefits, provider, Insurance verification, Insurance, salesforce.com, salesforce software, Case management, Prior authorization

Additional Skills & Qualifications

• Outbound calls -Payers, providers, and patient contact -Medicare experience needed, Government plans -Pharmacy and medical benefits, heavier pharmacy
• Inbound Call **transfer only to assist with 3rd Party Pushback (obtaining consent from patient or MDO to obtain benefits* Must have full understanding on the Reimbursement Process for pharmacy benefits.

Experience Level

Intermediate Level

Pay and Benefits

The pay range for this position is $20.00 - $22.00/hr.

Eligibility requirements apply to some benefits and may depend on your job
classification and length of employment. Benefits are subject to change and may be
subject to specific elections, plan, or program terms. If eligible, the benefits
available for this temporary role may include the following:

• Medical, dental & vision
• Critical Illness, Accident, and Hospital
• 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave)

Workplace Type

This is a fully onsite position in Morrisville,NC.

Application Deadline

This position is anticipated to close on Nov 3, 2025.

h4>About TEKsystems:

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

We’re a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We’re a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. We’re strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We’re building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com.

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.