TalentBridge, a leader in the professional staffing industry, is seeking candidates for a contract opportunity as Reimbursement Case Manager . The Reimbursement Case Manage is responsible for customer service, case management, reimbursement as well as working interactively with patients, healthcare providers, pharmacies, and manufacturer clients.
- Acts as a single point of contact and voice for all providers and patients.
- Serves as a patient advocate and enhances the caller/contact experience
- Manages case load depending on the parameters of the program
- Collects and review all patient information, to the degree authorized by the SOP of the program
- Validates completeness of all required information and provides assistance to provider and/or patient
- Determines patient's eligibility and conducts patient enrollment activities (example patient assistance programs and copay assistance)
- Performs reimbursement related activities such as benefit investigations, prior authorizations, appeals, etc.
- Provide exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly
- Maintain frequent phone contact with patients, provider representatives, third party customer service representatives and pharmacy staff
- Reports all Adverse Events (AE) disclosed in alignment with training and Standard Operational Procedures (SOP)
- Ability to multi-task and adapt to changing priorities
- Competency in MS Word and Excel
- Knowledge of HIPAA regulations
- Detailed oriented and highly organized
- Knowledge of pharmacy benefits, and medical benefits
- Global understanding of commercial and government payers preferred
- Ability and initiative to work independently or as a team member
- Previous 3+ years of experience in a specialty pharmacy, medical insurance, reimbursement hub experience, physician's office, healthcare setting, and/or insurance background preferred
- Bachelor's Degree Preferred
*** Candidates considered for these roles will need to be in one of the following states: Alabama, Arizona, Arkansas, Colorado, Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kentucky, Maryland, Michigan, Minnesota, Missouri, Montana, New Jersey, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, or Virginia. ***