Reimbursement Case Manager - Specialty Pharma

Medix; Bedford (TX); Hybrid; USD 52,000 - 66,000; Full time

Job summary

Medix is seeking a dedicated Patient Assistance & Co-Pay Reimbursement Case Manager to join our team for a temporary contract project in Bedford, Texas.

You will provide critical financial navigation and case management support for specialty pharmaceutical therapies, working directly with patients, healthcare providers, specialty pharmacies, and hub teams to remove financial barriers and secure access to co-pay savings and PAP funding.

Qualifications

• 2+ years of experience in insurance coordination, prior authorization, or pharmacy benefits.
• Strong working knowledge of pharmacy benefits and payer processes.
• Pharmacy Technicians with payer or PBM experience encouraged to apply.
• Hands-on experience with co-pay programs, patient assistance programs (PAP), or specialty reimbursement.
• A quiet, private, HIPAA-compliant home office workspace.
• Proficiency in basic Microsoft Office programs and case management data entry.
• High School Diploma or GED required.
• Ability to pass a mandatory program credentialing assessment during the assignment.

Responsibilities

• Perform high-volume inbound and outbound calls to patients and healthcare provider offices to deliver real-time updates on benefit investigations, prior authorizations, co-pay card options, and PAP coverage.
• Serve as the primary point of contact for patients and healthcare teams navigating complex insurance processes, free-goods initiatives, and charitable foundation funding.
• Manage a task-based caseload of 20–28 cases daily, accurately reviewing financial documentation, verifying income eligibility, and updating records in real time.
• Evaluate patient financial eligibility and facilitate enrollment into manufacturer co-pay programs, assistance grants, and safety-net solutions.
• Provide professional, compassionate support to patients experiencing stress related to their treatment and financial requirements.
• Maintain complete, audit-ready interaction records within the case management system, adhering to HIPAA guidelines and corporate compliance standards.

Skills

Insurance coordination

Prior authorization

Pharmacy benefits

PAP / co-pay programs

HIPAA compliance

Office software

Education

High School Diploma or GED

Tools

Microsoft Office

Job description

Reimbursement Case Manager – Specialty Pharma (258254) Bedford, Texas

We are seeking a dedicated Patient Assistance & Co-Pay Reimbursement Case Manager to join our team for a temporary contract project . In this role, you will provide critical financial navigation and case management support for specialty pharmaceutical therapies . You will work directly with patients, healthcare providers, specialty pharmacies, and hub teams to remove financial barriers, clear prior authorizations, and secure access to co-pay savings and charitable foundation assistance .

Location & Equipment: Remote, but candidates must reside within 50 miles of 3301 Airport Freeway, Bedford, TX 76021 . In-person equipment pickup and drop-off at this location is required at the beginning and end of the assignment .

Duration: Temporary Contract (Beginning December through March, with potential extension based on business needs) .

Shift/Schedule: Monday–Friday; must be available to work any 8-hour shift between 7:00 AM – 7:00 PM CST .

Paid Training: December 7th – December 11th (Monday–Friday, 8:00 AM – 5:00 PM CST) .

Orientation: Mandatory remote orientation session in late November .

Attendance Policy: High-reliability requirement; no time off is permitted during the contract period (pre-planned single medical appointments may be accommodated with advance notice) .

Key Responsibilities

• Financial Access Support: Perform high-volume inbound and outbound calls to patients and healthcare provider offices to deliver real-time updates on benefit investigations, prior authorizations, co-pay card options, and Patient Assistance Program (PAP) coverage .
• Patient Advocacy: Serve as the primary point of contact for patients and healthcare teams navigating complex insurance processes, free-goods initiatives, and charitable foundation funding .
• Case Processing: Manage a task-based caseload of 20–28 cases daily, accurately reviewing financial documentation, verifying income eligibility, and updating records in real time .
• Eligibility & Enrollment: Evaluate patient financial eligibility and facilitate seamless enrollment into manufacturer co-pay programs, assistance grants, and safety-net solutions .
• Empathetic Communication: Provide professional, compassionate support to patients experiencing stress related to their treatment and financial requirements .
• Compliance & Data Integrity: Maintain complete, audit-ready interaction records within the case management system, strictly adhering to HIPAA guidelines and corporate compliance standards .

Required Qualifications

• Experience: 2+ years of experience in insurance coordination, prior authorization, or pharmacy benefits .
• Domain Knowledge: Strong working knowledge of pharmacy benefits, Medicare Part D, prior authorization workflows, and payer processes .
• Pharmacy Background: Pharmacy Technicians with payer or Pharmacy Benefit Manager (PBM) experience are encouraged to apply (retail-only pharmacy experience does not qualify) .
• Program Experience: Hands-on experience with co-pay programs, patient assistance programs (PAP), or specialty reimbursement .
• Workspace Requirements: A quiet, private, HIPAA-compliant home office workspace .
• Technical Skills: Proficiency in basic Microsoft Office programs and case management data entry .
• Education: High School Diploma or GED required .
• Credentialing: Ability to pass a mandatory program credentialing assessment during the assignment .

Preferred Qualifications

• Prior experience as a Reimbursement Case Manager (RCM) or Hub Case Manager .

Key Attributes for Success

• Excellent critical thinking and independent problem-solving capabilities .
• Ability to thrive in a fast-paced, high-volume, and metrics-driven environment .
• Outstanding verbal and written communication skills with strong active listening abilities .