Senior Reimbursement Specialist – Patient Access

CareMetx, LLC; Kissimmee (FL); On-site; USD 65,000 - 90,000; Full time

Job summary

CareMetx is seeking a Senior Reimbursement Case Manager to support patients, providers, and payers. Under supervision, you will handle benefits investigations, prior authorization support, and call triage while ensuring HIPAA compliant documentation in the CareMetx Connect system.

You will manage a regional caseload, communicate with payors, and facilitate access to therapies. The role requires 3+ years in healthcare or insurance, a Bachelor's preferred, and strong MS Word/Excel skills.

Qualifications

• 3+ years in a physician's office, healthcare setting, or insurance background preferred.
• Bachelor’s Degree preferred.
• HIPAA knowledge.
• Excellent verbal and written communication.
• Ability to multi-task and adapt to changing priorities.

Responsibilities

• Serve as a single point of contact for providers, patients, and product team.
• Handle escalated accounts and issues.
• Coordinate access to therapies and prior authorizations.
• Document interactions in CareMetx Connect per HIPAA regulations.
• Track and follow up on prior authorizations and appeals.
• Provide exceptional customer service to internal and external customers.

Skills

Communication skills

Multitasking

Detail-oriented

Interpersonal skills

Pharmacy benefits knowledge

Payer landscape knowledge

Education

Bachelor's Degree preferred

Tools

MS Word

MS Excel

Job description

CareMetx is seeking a Senior Reimbursement Case Manager to support patients, providers, and payers. Under supervision, you will handle benefits investigations, prior authorization support, and call triage while ensuring HIPAA compliant documentation in the CareMetx Connect system.

You will manage a regional caseload, communicate with payors, and facilitate access to therapies. The role requires 3+ years in healthcare or insurance, a Bachelor's preferred, and strong MS Word/Excel skills.