Reimbursement Case Manager

Mercalis

1d•Onsite

About The Position

As a Reimbursement Case Manager, you provide inbound and outbound phone support and serve as the primary contact for patients, caregivers, and providers. You will facilitate a collaborative process that gauges, coordinates, and monitors patient needs and appropriately facilitate a patient’s journey utilizing services offered through the Patient Support Program on behalf of a manufacturer. The primary function is to provide unparalleled customer service to patients, caregivers and providers as a dedicated contact by coordinating resources, exchanging information and ensuring appropriate delivery of services. These services include handling the day-to-day activities within reimbursement services, such as daily interactions with healthcare insurance companies to verify the financial aspects of healthcare services to ensure patients have access to life saving treatments they need.

Requirements

Associate or Bachelor’s degree preferred; or a minimum of 4 years of call center or customer service experience with progressive levels of responsibility within a service driven environment
Ability to communicate effectively both orally and in writing
Knowledge of medical insurance terminology and reimbursement/insurance, healthcare billing, physician office, health insurance processing or related experience
Excellent problem-solving and decision-making skills required
Attention to detail and committed follow through in communication with patients, providers and internal stakeholders
Strong organizational skills
Willing to work in a dynamic, fast paced environment and have the ability to multi-task and adapt to change while adhering to Program Standards
Strong interpersonal skills, ability to work both independently and as part of a team, ability to jump in and help others as needed
Empathetic listening skills in order to interact effectively with patients and providers
Punctual, reliable with strong attendance record
Proficient with Microsoft products
Candidates who can type at least 35 words per minute with 97% accuracy.

Nice To Haves

Flexibility to travel as needed is preferred.

Responsibilities

Serve as an expert on reimbursement, co-pay, foundation assistance, PAP issues, and other forms of available support and will be responsible for handling patient and healthcare provider interactions
Serve as an advocate to patients regarding eligibility requirements, program enrollment, reimbursement process, affordability support, and general access for prescribed therapy
Establish relationships, develop trust, and maintain rapport with patients, payers and healthcare providers
Serve as direct point of contact to health care providers for ongoing support and relationship development by acquiring and delivering detailed information regarding a program and/or a patient
Serve as a resource for patients and healthcare professionals to verify insurance coverage, medical billing, reimbursement process, and general access for complex pharmaceuticals
Evaluate program enrollment forms for data integrity
Responsible for insurance benefit investigations, and triage cases according to program standard operating procedures
Follow program guidelines and escalate complex cases according to program policy, SOPs, Call Guides, and other program materials.
Working case management system, documenting status/background in case notes, communicating patient benefits, assisting in the PA/Appeals process and like responsibilities
Ability to understand and explain benefits offered by all payer types including private/commercial and government (i.e., Medicare, Medicaid, VA and DOD)
Act as an assigned liaison to client contacts (e.g., regional contact for sales representatives), Program Management, other internal stakeholders and Healthcare Providers
Maintain records in accordance with applicable standards and regulations to the programs/promotions
Provide unparalleled customer service while serving as a brand advocate and program representative; understands the importance of achieving quality outcomes and commit to the appropriate use of resources
Works with the Program Manager, on a day-to-day basis to maintain open lines of communication and share awareness regarding patient status, prescriber feedback/satisfaction and program effectiveness
Understand health and disease states of patients of the programs
Maintains a high level of ethical conduct regarding confidentiality and privacy
Help maintain team morale by consistently demonstrating positive attitude
On time adherence to training deadlines for all corporate policies and procedures governing access to confidential data
Ensure all SOPs are followed with consistency
Conducts miscellaneous tasks or projects as assigned
Identify and report pharmacovigilance information as required by client(s) (i.e., Adverse Events) – (specific to program/client requirements)

Benefits

Medical, dental, and vision plans, including HSA- and FSA-eligible options, with Valeris contributing toward premium costs
Additional health support, including telehealth and Employee Assistance Program (EAP) services
Company match on Health Savings Account contributions
Free Basic Life and AD&D coverage equal to your annual earnings, with a minimum of $50,000 and a maximum of $300,000
Company-paid Short-Term Disability coverage, with the option to purchase Long-Term Disability
401(k) Retirement Savings Plan with 100% match on the first 5% you contribute, with immediate vesting
Paid Time Off (PTO) and Sick Leave to support work-life balance
Team members receive nine paid holidays plus two floating holidays
Opportunities for advancement in a company that supports personal and professional growth
A challenging, stimulating work environment that encourages new ideas
Work for a company that values diversity and makes deliberate efforts to create an inclusive workplace
A mission-driven, inclusive culture where your work makes a meaningful impact