CareMetx, LLC · 7 hours ago
Reimbursement Case Manager
United States
Full-time
Onsite
Mid Level
3+ years expCareMetx, LLC is dedicated to delivering industry-leading patient access solutions and support services. The Reimbursement Case Manager is responsible for customer service and case management, working interactively with patients, healthcare providers, pharmacies, and manufacturer clients to facilitate access to therapies and support services.
BiotechnologyInformation Technology
Responsibilities
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
Performs other related duties as assigned
Qualification
Required
Previous 3+ years of experience in a specialty pharmacy, medical insurance, reimbursement hub experience, physician's office, healthcare setting, and/or insurance background preferred
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
Detailed oriented and highly organized
Excellent interpersonal skills
Knowledge of pharmacy benefits, and medical benefits
Ability and initiative to work independently or as a team member
Ability to problem solve
Customer satisfaction focused
Maintain regular and reliable attendance, including being present, on time, and prepared for work as scheduled
Preferred
Bachelor's Degree Preferred
Global understanding of commercial and government payers preferred
Company
CareMetx, LLC
CareMetx, LLC is a leading technology-enabled patient services partner, providing high-touch support to accelerate patient initiation and adherence for specialty therapies.
501-1000 employees
H1B Sponsorship
CareMetx, LLC has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (1)
2024 (3)
2023 (5)
2022 (3)
2021 (4)
2020 (7)
Funding
Current Stage
Late StageTotal Funding
unknown2021-01-14Acquired
Leadership Team
Jim Rowe
President and CEO
Kurt Brumme
Chief Financial Officer
Recent News
2025-10-21
2025-09-19
2025-06-04
Company data provided by crunchbase