Hybrid Remote Reimbursement Case Manager

RareMed Solutions; Coraopolis (Allegheny County); Hybrid; USD 52,000 - 76,000; Full time

Benefits offered by this job

Hybrid work model

Office in Pittsburgh, PA area

Job summary

RareMed Solutions in the United States seeks a Reimbursement Case Manager to serve as the primary payer contact, manage benefits verification, prior authorization, and appeals support, and collaborate with internal teams to resolve reimbursement inquiries.

This hybrid role requires 2+ years in reimbursement or healthcare, strong communication, attention to detail, and the ability to work within SOPs and service levels, with shifts between 8 AM and 8 PM EST.

Qualifications

• 2+ years recent reimbursement experience required.
• Experience in pharmacy/healthcare setting or pharmacy/medical insurance background is preferred.
• Advanced knowledge in healthcare settings and benefit investigation.
• Ability to communicate clearly with customers and maintain satisfaction.
• Ability to manage case load independently and meet deliverables.
• Strong analytical and organizational skills with attention to detail.

Responsibilities

• Serve as primary point of contact for client reimbursement inquiries and escalations.
• Coordinate investigation and determination of patient benefits with internal teams and plans.
• Review forms for completeness and communicate missing information for benefit verification.
• Apply defined business rules to qualify patients for manufacturer programs.
• Work independently following SOPs to complete benefits verification and authorization processes.
• Maintain accurate documentation on all accounts per SOPs.
• Proactively enroll eligible patients into the commercial copay program.
• Communicate with payer trends and reimbursement insights to program management.

Skills

Reimbursement experience

Healthcare customer service

Communication skills

Time management

Analytical skills

Education

High school diploma

Pharmacy Technician Certification (CPhT) - preferred

Tools

Microsoft Teams

Excel

Outlook

Word

Job description

RareMed Solutions in the United States seeks a Reimbursement Case Manager to serve as the primary payer contact, manage benefits verification, prior authorization, and appeals support, and collaborate with internal teams to resolve reimbursement inquiries.

This hybrid role requires 2+ years in reimbursement or healthcare, strong communication, attention to detail, and the ability to work within SOPs and service levels, with shifts between 8 AM and 8 PM EST.