- Applies acquired job skills and company policies and procedures to complete standard tasks
- Works on routine assignments that require basic problem resolution
- Refers to policies and past practices for guidance
- Receives general direction on standard work; receives detailed instruction on new assignments
- Refers to policies and past practices for guidance
- Receives general direction on standard work; receives detailed instruction on new assignments
- Consults with supervisor or senior peers on complex and unusual problems
Accountabilities The Case Manager supports patient access to therapy through Reimbursement Support Services in accordance with the program business rules and HIPAA regulations. This position is responsible for guiding the healthcare providers through the various process steps in support of their patient s journey to therapy. These steps include patient referral intake, investigating all patient health insurance benefits, identifying & initiating prior authorization and step therapy reviews, proactively following up with various partners including the insurance payers, specialty pharmacies, and support organizations to facilitate coverage and delivery of product in a timely manner. - Must demonstrate efficiency and strong organizational skill
- Mediate effective resolution for complex payer/pharmacy issues toward a positive outcome to de-escalate
- Proactive follow-up with various contacts to ensure patient access to therapy
- Call interactions are inbound & outbound: Must demonstrate superior customer support talents that remain in compliance with standard call quality expectations.
- Must communicate clearly and effectively in both a written and verbal format
- Must meet the daily task and benefit investigation goals associated with a high enrollment volume/low patient interaction program.
Qualifications - High School Diploma, GED, or equivalent work experience
- 3-6 years experience in related field preferred
- 1-2 years experience conducting and documenting patient health insurance benefit investigations, prior authorizations, and appeals, preferred
- Knowledge of Medicare, Medicaid and Commercially insured payer common practices and policies, preferred
- Critical and creative thinking, preferred
- Knowledge of the Health Insurance Market Place and the Affordable Care Act preferred
- Knowledge of Medical/Pharmacy billing and coding is preferred
- Important to have a strong attention to detail
TRAINING AND WORK SCHEDULES: Your new hire training will take place 8:00am-5:00pm CT, mandatory attendance is required. This position is full-time (40 hours/week). Employees are required to have flexibility to work shift schedules during our normal business hours of Monday-Friday, 7:00am- 7:00pm CT. |
| Skills: | REMOTE DETAILS: All U.S. residents are eligible to apply to this position. You will work remotely, full-time. It will require a dedicated, quiet, private, distraction free environment with access to high-speed internet. We will provide you with the computer, technology and equipment needed to successfully perform your job. You will be responsible for providing high-speed internet. Internet requirements include the following: Maintain a secure, high-speed, broadband internet connection (DSL, Cable, or Fiber) at the remote location. Dial-up, satellite, WIFI, Cellular connections are NOT acceptable. Download speed of 15Mbps (megabyte per second)
" Upload speed of 5Mbps (megabyte per second)
" Ping Rate Maximum of 30ms (milliseconds)
" Hardwired to the router
" Surge protector with Network Line Protection for CAH issued equipment Inability to meet these requirements at any time may result in termination of the contract / employment. |
| Education: | " Minimum of HS diploma; additional education preferred
" Previous healthcare experience with insurance or in pharmaceutical industry, preferred
" Pharmacy benefits management experience preferred with specific knowledge of Medicare, Medicaid and commercially insured payer common practices and policies, preferred
" Previous prior authorization and appeals experience highly desired |