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Customer Service
Reimbursement Case Manager
@Caremetx
[Hiring] Reimbursement Case Manager @Caremetx
Mar 28, 2025 - Caremetx is hiring a remote Reimbursement Case Manager. đź’¸ Salary: $38,418.30 - $51,224.15. đź“ŤLocation: USA.
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Role Description
The Reimbursement Case Manager is responsible for customer service and case management under the general supervision of the operational program leadership.
- Acts as a single point of contact and voice for all providers and patients.
- Works as a patient advocate and always demonstrates compassion.
- Coordinates access to therapies, conducts appropriate follow-up, and facilitates access to appropriate support services.
- Manages case load depending on the parameters of the program.
- Collects and reviews all patient information, to the degree authorized by the SOP of the program.
- Validates completeness of all required information and provides assistance to provider and/or patient.
- Provides guidance to physician office staff and patients on how to complete and submit all necessary program applications in a timely manner.
- Determines patient’s eligibility and conducts patient enrollment activities (e.g., patient assistance programs and copay assistance).
- Performs reimbursement-related activities such as benefit investigations, prior authorizations, appeals, etc.
- Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly.
- Maintains frequent phone contact with patients, provider representatives, third-party customer service representatives, and pharmacy staff.
- Provides reimbursement information to providers and/or patients.
- Reports all Adverse Events (AE) disclosed in alignment with training and Standard Operational Procedures (SOP).
- Coordinates with inter-departmental associates as necessary.
- Works on problems of moderate scope where analysis of data requires a review of a variety of factors.
- Exercises judgment within defined standard operating procedures to determine appropriate action.
- Typically receives little instruction on day-to-day work, general instructions on new assignments.
- Maintains extensive knowledge of HIPAA regulations and follows all company policies.
- Maintains regular and reliable attendance, including being present, on time, and prepared for work as scheduled.
- Performs other duties as assigned; duties, responsibilities, and activities may change or new ones may be assigned at any time with or without notice.
Qualifications
- Previous 3+ years of experience in a specialty pharmacy, medical insurance, reimbursement hub experience, physician’s office, healthcare setting, and/or insurance background preferred.
- Bachelor’s Degree Preferred.
Requirements
- Excellent verbal and written communication skills.
- Ability to multi-task and adapt to changing priorities.
- Proficient keyboard skills.
- Competency in MS Word and Excel.
- Knowledge of HIPAA regulations.
- Detail-oriented and highly organized.
- Excellent interpersonal skills.
- Knowledge of pharmacy benefits and medical benefits.
- Global understanding of commercial and government payers preferred.
- Ability and initiative to work independently or as a team member.
- Ability to problem solve.
- Customer satisfaction focused.
Physical Demands
- The employee is regularly required to sit.
- The employee must occasionally lift and/or move up to 10 pounds.
Work Environment
- The noise level in the work environment is usually moderate.
Schedule
- Must be flexible on schedule and hours.
- Overtime may be required from time to time.
- Must be willing to work weekends if required to meet company demands.
Salary Description
$38,418.30 - $51,224.15
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| đź“Ť | Be aware of the location restriction for this remote position: USA |
| ‼ | Beware of scams! When applying for jobs, you should NEVER have to pay anything. Learn more. |
Back to Remote jobs >
Customer Service
Customer Service
|
Salary
đź’¸
$38,418.30 - $51,224.15
|
Remote
Location
USA
|
|
Job Type
full-time
|
Posted
Mar 28, 2025
|
️
| đź“Ť | Be aware of the location restriction for this remote position: USA |
| ‼ | Beware of scams! When applying for jobs, you should NEVER have to pay anything. Learn more. |
