Reimbursement Case Manager

From intake to outcomes, CareMetx is dedicated to delivering industry-leading patient access solutions and support services that help patients quickly start and stay on specialty therapy treatments. We provide scalable, efficient digital hub services for pharmaceutical companies and healthcare providers, streamlining workflows with seamless integration for patient enrollment, consent, and prior authorization. Our best-in-class patient support services enhance every step of care, connecting patients, providers, and brands to drive better outcomes and accelerate time-to-therapy.

Under the general supervision of the operational program leadership, the Reimbursement Case Manager is responsible for customer service and case management. The Reimbursement Case Manager will work interactively with patients, healthcare providers, pharmacies, and manufacturer clients. The team will also support various reimbursement and patient assistance functions. The Reimbursement Case Manager responds to all patient, and provider account inquiries. Documents all interactions into the CareMetx Connect system in compliance with HIPAA regulations. 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

Acts as a single point of contact and voice for all providers and patients. Works as a patient advocate and always demonstrates compassion Serves as a patient advocate and enhances the caller/contact experience 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 review 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 Provide 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 (example patient assistance programs and copay assistance) Performs reimbursement related activities such as benefit investigations, prior authorizations, appeals, etc. Provide exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly Maintain 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) Coordinate with inter-departmental associates as necessary Work on problems of moderate scope where analysis of data requires a review of a variety of factors. Exercise judgment within defined standard operating procedures to determine appropriate action Typically receives little instruction on day-to-day work, general instructions on new assignments Extensive knowledge of HIPAA regulations and follows all company policies Maintain regular and reliable attendance, including being present, on time, and prepared for work as scheduled. Other duties as assigned - Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice.