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Case Manager

Cary, NC

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Description

Our Cary NC client is seeking an Experienced Case Manager. This position requires the availability Monday - Friday between 8am to 8pm. This is a very fast paced and high volume call center environment that provides program specific access and reimbursement support to patients, healthcare providers, and manufacturer representatives. 

Position Description

  • Will frequently interact via telephone with commercial payers to conduct benefits verification.
  • Works daily with commercial payers to  ensure appropriate coverage and reimbursement in a variety of therapeutic areas.
  • Must have a solid working knowledge of insurance plans and benefit structures in order to obtain detailed benefit information and maximize plan benefits.
  • Obtains payer specific prior authorization procedures and documentation requirements and share overall benefits verification results with healthcare providers and patients.
  • A general understanding of Medicare and Medicaid programs is desired.

Key Responsibilities

  1. Contact payers to verify patient eligibility and product specific coverage information. 
  2. Assist patients and physicians with prior authorization,appeal management, nurse training and home health administration.
  3. Interface with physicians, patients, and manufacturer representatives to obtain and provide drug specific coverage information.
  4. Provide support and screening for patient assistance program and co-pay offerings.
  5. Conduct research to identify appropriate alternate funding sources and make recommendation
  6. Provide accurate and timely follow-up to all reimbursement inquires in accordance with program guidelines.
  7. Ensure that the intake information is entered accurately and completely in order to perform all reimbursement research.
  8. Research and compile payer specific information for reimbursement database.
  9. Complete end to end processing of new referrals and re-enrollments
  10. Follow program cadence for outreach to patients and health care providers to ensure patient can start therapy on time.
  11. Complete healthcare provider's credentialing for online portal access to HCP and office staff.

 

 

Job Requirements

Minimum Requirements

  • High School diploma or equivalent
  • 5+ years of customer service experience within a healthcare environment.
  • 5+ years of Medical Claims or insurance experience.
  • Experience in the healthcare industry including, but not limited to, insurance verification and/or claim adjudication, physician’s office or out patient billing, pharmacy and/or pharmaceutical manufacturers.
  • Must be able to compose and document benefit investigation outcomes and prepare written status reports to management on a regular basis.
  • Ability to work on multiple systems and take ownership of patient cases to ensure timely completion of all required steps in the process.
  • CPR+ system knowledge preferred.

Additional Knowledge/Skills

  • ICD-10 and HCPCS experience is preferred
  • Ability to effectively handle multiple priorities within a changing environment
  • Strong verbal and written communication skills in order to effective communicate with co-workers, insurance carriers, patients, and medical office personnel.
  • Strong organizational skills
  • Proficient is MS Office
  • Problem solving and decision-making skills
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