Remote Reimbursement Case Manager for Specialty Pharmacy

Employee Relations Associates, Inc.; Fort Mill (SC); Remote; USD 70,000 - 90,000; Full time

Benefits offered by this job

Medical insurance

Dental and Vision

Life insurance

Short-term disability

401(k)

Holiday pay

Job summary

TalentBridge is seeking an experienced Reimbursement Case Manager to join a leading national healthcare organization in the field of pharmaceutical patient support services. This role focuses on owning patient cases, navigating complex reimbursement challenges, and ensuring timely access to specialty medications for patients.

The ideal candidate has hands-on case management experience within healthcare reimbursement, with strong knowledge of prior authorizations, appeals, and patient assistance

Qualifications

• 3+ years of experience in healthcare reimbursement, specialty pharmacy, medical insurance, or patient support services preferred.
• Previous experience managing an assigned patient caseload within a pharmaceutical HUB or specialty pharmacy environment strongly preferred.
• Demonstrated experience managing patient cases from enrollment through benefits verification, reimbursement approval, and therapy access.
• Strong knowledge of benefits investigations, prior authorizations, appeals, copay assistance, and patient assistance programs.
• Experience working directly with patients, healthcare providers, pharmacies, and insurance companies.
• Understanding of commercial insurance, Medicare, Medicaid, and specialty medication reimbursement processes.
• Strong organizational skills with the ability to independently manage multiple active patient cases and competing priorities.
• Excellent communication, problem-solving, and patient advocacy skills.
• Experience documenting patient interactions and case progression within a healthcare CRM or case management platform.

Responsibilities

• Manage an assigned caseload of patients, serving as their primary point of contact throughout the reimbursement and therapy access process.
• Coordinate patient enrollment, benefits investigations, prior authorizations, appeals, and financial assistance programs.
• Work directly with patients, healthcare providers, specialty pharmacies, and insurance companies to resolve reimbursement barriers.
• Proactively monitor patient cases, conduct follow-ups, and ensure timely progression toward therapy access.
• Guide patients and physician offices through enrollment applications, insurance requirements, and patient assistance programs.
• Research and resolve complex insurance coverage issues, including prior authorization denials and appeals.
• Maintain accurate case documentation while ensuring compliance with HIPAA regulations and program guidelines.
• Collaborate with internal teams to resolve escalations and deliver exceptional patient support.

Skills

Patient case management

Healthcare reimbursement

Communication skills

Organizational skills

Job description

TalentBridge is seeking an experienced Reimbursement Case Manager to join a leading national healthcare organization in the field of pharmaceutical patient support services. This role focuses on owning patient cases, navigating complex reimbursement challenges, and ensuring timely access to specialty medications for patients.

The ideal candidate has hands-on case management experience within healthcare reimbursement, with strong knowledge of prior authorizations, appeals, and patient assistance