Patient Access Reimbursement Specialist

CareMetx, LLC; United States; Remote; USD 52,000 - 78,000; Full time

Job summary

CareMetx, LLC is seeking a Reimbursement Case Manager to serve as the frontline contact for patients and providers, guiding enrollment and reimbursement processes. You will manage case loads, verify eligibility, and coordinate access to therapies and assistance programs while ensuring HIPAA-compliant documentation and high-quality patient service.

The role involves reviewing complex information, collaborating with pharmacies and manufacturers, and maintaining accurate records in CareMetx

Qualifications

• 3+ years of experience in a specialty pharmacy, medical insurance, or reimbursement hub.
• Bachelor’s Degree preferred.

Responsibilities

• Acts as a single point of contact for providers and patients and advocates for them.
• Coordinates access to therapies and supports services.
• Reviews patient information for completeness per SOP.
• Determines eligibility and conducts enrollment in assistance programs.
• Performs reimbursement tasks such as benefit investigations and prior authorizations.
• Provides timely, accurate responses to inquiries and escalates as needed.
• Maintains HIPAA compliance and documents interactions in CareMetx Connect.
• Collaborates with other departments as necessary.

Skills

Excellent verbal and written comms

Multitasking

MS Word & Excel

HIPAA regulations

Organized & detail oriented

Pharmacy benefits knowledge

Patient advocate

Education

Bachelor’s Degree Preferred

Job description

CareMetx, LLC is seeking a Reimbursement Case Manager to serve as the frontline contact for patients and providers, guiding enrollment and reimbursement processes. You will manage case loads, verify eligibility, and coordinate access to therapies and assistance programs while ensuring HIPAA-compliant documentation and high-quality patient service.

The role involves reviewing complex information, collaborating with pharmacies and manufacturers, and maintaining accurate records in CareMetx