Remote Case Manager, Reimbursement & Appeals

United BioSource; United States; Remote; USD 65,000 - 90,000; Full time

Benefits offered by this job

Remote opportunities

Promotion opportunities

401K with company match

Tuition reimbursement

Flexible work environment

20 Days PTO

Paid Holidays

Employee assistance programs

Medical, Dental, and vision coverage

HSA/FSA

Wellness program

Adoption assistance

Short term disability

Long term disability

Life insurance

Discount programs

Job summary

UBC in the United States is seeking a Case Manager, Reimbursement to oversee day-to-day caseload activities, ensure timely completion of prior authorizations, reauthorizations and appeals, and act as the primary resource for patients and providers.

Responsibilities include documenting payer information, assessing eligibility for services such as injection programs and PAP, and coordinating with field reimbursement and other stakeholders to support start of therapy.

Qualifications

• Bachelor's degree or six years of relevant working experience.
• Two or more years of relevant experience in pharmacy benefit management.
• Medical Assistant, Social Worker or Senior Reimbursement Specialist experience preferred.
• Certification preferred but not required.
• Proficient in Microsoft Office applications.
• Knowledge of medical and claims processing terminology.
• Excellent written/verbal communication to include providing clear instructions.
• Must possess a strong critical thinking skillset along with the ability to multi-task.

Responsibilities

• Provide day-to-day oversight and coordination of caseload to ensure all case elements and tasks are completed timely and cases move through the process as required.
• Act as single point of contact responsible for prior authorization and appeal processing communications to patients, healthcare providers, field reimbursement representatives and other external stakeholders.
• Communicate patient benefits and responsibility timely and accurately.
• Assess and refer patients appropriately for special programs/services when appropriate.
• Performs quality checks on cases and report trends to leadership.
• Responsible for good housekeeping techniques, adhering to quality and production standards while complying with all applicable company, state and federal safety and environmental programs and procedures.
• Troubleshoot complex cases, spanning multiple disease-states, while interfacing with key stakeholders to ensure optimal start to therapy.
• Report Adverse Drug Events that have been experienced by the patient in accordance pharmaceutical requirements.
• Recognize a product quality complaint and forward caller/written information to a manufacturer.
• Other duties, as assigned.

Skills

Pharmacy benefit management

Microsoft Office

Communication

Critical thinking

Multitasking

Education

Bachelor's degree

Certification preferred

Tools

Microsoft Office Suite

Job description

UBC in the United States is seeking a Case Manager, Reimbursement to oversee day-to-day caseload activities, ensure timely completion of prior authorizations, reauthorizations and appeals, and act as the primary resource for patients and providers.

Responsibilities include documenting payer information, assessing eligibility for services such as injection programs and PAP, and coordinating with field reimbursement and other stakeholders to support start of therapy.