27 applicants

Company

ProPharma · 1 day ago

Reimbursement Case Manager, Patient Services

United States

Full-time

Remote

Mid, Senior Level

5+ years exp

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Responsibilities

Benefits Verification: Verify patients’ insurance coverage (both medical and pharmacy benefits), co-pays, and eligibility for reimbursement programs.

Prior Authorizations: Initiate and manage prior authorizations, collaborating closely with patients, prescribers and insurance companies.

Appeals Support: Guide patients and prescribers through the appeal process, ensuring they have the necessary information and documentation. Collaborate with healthcare providers, insurance companies, and patients to resolve denied claims and secure optimal reimbursement.

Financial Assistance Programs: Help patients access co-pay assistance, manufacturer support, patient assistance programs, and alternate funding options.

New Patient Intake: Receive and process new patient referrals and gather necessary information for enrollment.

Welcome Calls: Reach out to newly enrolled patients, providing information about the program and addressing any initial questions or concerns.

Documentation: Maintain accurate records of patient intake details.

Inbound Calls: Handle incoming calls from patients, healthcare providers, and pharmacies.

Patient Inquiries: Address patient inquiries related to reimbursement, benefits, and program details.

Problem Resolution: Resolve issues promptly, ensuring a positive patient experience.

Refill Requests: Process refill requests from existing patients, coordinating with specialty pharmacies.

Stakeholders: Partner with stakeholders (Sales, Specialty Pharmacies) to develop strategic approaches for reimbursement support.

Client Field Team: Communicate with client field representatives to address patient access issues.

Healthcare Providers (HCPs): Collaborate with HCPs to streamline reimbursement processes.

Advocate for Patients: Ensure patients receive maximum reimbursement benefits.

Educate Patients: Explain reimbursement processes, co-pay options, and financial assistance programs.

Empower Adherence: Emphasize the importance of medication adherence for successful outcomes.

Adherence to Policies: Follow established protocols, guidelines, and compliance standards.

Audit Documentation: Maintain accurate and complete records for audits and reporting.

Other duties as assigned.

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Healthcare systems knowledgeReimbursement access programsPatient Management ApplicationsSalesforce proficiencyCustomer supportMicrosoft OfficeMedical codingPharmacy benefits knowledgePharmacy Technician License

Required

Bachelor’s degree in a relevant field such as Healthcare Administration, Business, or a related discipline.

In lieu of a bachelor’s degree, candidates must possess a minimum of 5-7 years of expertise in patient services, insurance reimbursement, insurance verification, both medical and pharmacy and/or medical coding and billing, and/or pharmacy technician experience.

Active Pharmacy Technician License or Certified Pharmacy Technician (CPHT) certification. If not currently licensed, the candidate must secure the necessary licensure within 30 days of hire.

Minimum of 5 years of experience in patient services/support and access, including patient financial assistance, reimbursement coordination with pharmacy and medical benefits, prior authorizations, appeals, medical coding, coverage policies, and policy management.

A strong understanding of healthcare systems, patient support services, and relevant regulations is crucial.

Strong knowledge of reimbursement (both medical and pharmacy benefits) access programs and financial assistance programs.

Excellent verbal, written communication and relationship-building skills.

Proficiency in using Patient Management Applications, preferably Salesforce and other database systems.

Strong problem-solving skills are essential to address issues promptly when encountering challenges related to patient access, reimbursement, and compliance.

Ability to adapt to changes and stay informed about industry trends and adjust strategies accordingly as the healthcare landscape evolves rapidly.

Flexibility adapting to changing business priorities and requirements.

Demonstrated ability to provide outstanding customer support.

Meticulous attention to detail ensuring accuracy and quality.

Strong organizational and prioritization abilities, capable of multitasking efficiently.

Ability to work independently and collaboratively within a multidisciplinary team.

Willingness to work extended or flexible hours to meet client needs.

Proficient in computer usage and keyboarding skills.

Skilled in using Microsoft Office applications (Outlook, Word, Excel, PowerPoint).

Strong ability to work effectively within a team environment.

Preferred

Call center experience.

Company

ProPharma

Glassdoor

3.1

ProPharma is the premier Research Consulting Organization (RCO), delivering fully customizable consulting solutions to empower biotech, med device, and pharmaceutical organizations of all sizes to advance scientific breakthroughs confidently and introduce new therapies.

Founded in 2001

Overland Park, Kansas, USA

5,001-10,000 employees