Case Manager, Reimbursement - Evening Shifts

United Biosource Corporation•All Virtual Locations, Home Based Position, USA, Remote, US,

6d•Remote

About The Position

The Case Manager, Reimbursement provides day-to-day oversight and coordination of an assigned caseload, ensuring case tasks are completed on time and cases progress as required. The role is a primary resource and single point of contact for patients, healthcare providers, field reimbursement representatives, and other external stakeholders regarding prior authorizations and appeals. The Case Manager ensures prior authorizations, reauthorizations, and appeals are obtained promptly and that payer information and patient status are documented accurately. The role also conducts pre-screens to determine eligibility for additional services, such as injection services, co-pay mitigation, and patient assistance programs, when applicable. This is a primarily remote, full-time position supporting business operations Monday through Friday from 11:00 a.m. to 8:00 p.m. Eastern Time. Assigned schedules depend on business and client needs. Candidates outside the Eastern Time Zone may apply but must be able to work the assigned Eastern Time schedule. Occasional travel may be required for client, business, or training needs.

Requirements

Bachelor’s degree or six years of relevant work experience.
Proficiency in Microsoft Office applications.
Knowledge of medical and claims processing terminology.
Excellent written and verbal communication skills, including the ability to provide clear instructions.
Strong critical-thinking skills and the ability to multitask.
Willingness and ability to travel as needed; travel is expected to be infrequent and may depend on client, business, or training needs.
Availability to work the assigned full-time schedule of 11:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday.

Nice To Haves

Two or more years of relevant experience in pharmacy benefit management.
Medical Assistant, Social Worker, or Senior Reimbursement Specialist experience.
Certification.

Responsibilities

Provide day-to-day oversight and coordination of an assigned caseload, ensuring case elements and tasks are completed on time and cases progress as required.
Serve as the single point of contact for prior authorization and appeal processing communications with patients, healthcare providers, field reimbursement representatives, and other external stakeholders.
Communicate patient benefits and financial responsibility accurately and promptly.
Assess patients and refer them to special programs or services when appropriate.
Perform quality checks on cases and report trends to leadership.
Follow good housekeeping techniques and comply with quality and production standards and applicable company, state, and federal safety and environmental programs and procedures.
Troubleshoot complex cases across multiple disease states and coordinate with internal and external stakeholders to support timely therapy initiation.
Report patient adverse drug events in accordance with pharmaceutical requirements.
Recognize product quality complaints and forward caller or written information to the manufacturer.
Perform other duties as assigned.