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Case Manager -Reimbursement Manager (health care )

Phoenix, AZ

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Description

Our client is a responsible, well respected name in health care patient services.   Due to growth , adding to the team. Focus on Specialty Drugs Reimbursement   

Work in Office - North Phoenix.    Pay rate 78 - 85 K DOE  

Must be an Expert in Health Insurance Billing & Reimbursement for SPECIALTY DRUGS,    

Overall responsibility for multi-state new patient referrals through the prior auth process, management for the most difficult patient cases, problem resolution and decision making, with ability to back-up decisions, plus educate and guide the Insurance Specialists on the team.  With goal of obtaining approvals for the drug therapy. 

Knowledge set:  

  • Case management - 100% focus on the process for Specialty drugs)
  • Billing and coding updates
  • Appropriate claims submission
  • Specialty Pharmacy
  • Medical Benefit Interpretation
  • Understanding medical necessity
  • Claims / Appeal assistance
  • Information related to co-pay assistance programs
  • Information related to patient assistance programs

Additionally   

Establishing relationships with the payers and call on existing relationships 

Interface with physicians and drug manufacturer representatives to obtain and provide patient and provider specific information.

Research and compile provider / manufacturer representative specific information for reimbursement database.

Advise and coordinate with IT for insurance contract interpretations to load in the system

 

Job Requirements

Minimum Requirements

  • BA degree in Business or Healthcare
  • Minimum of 8 years specialty drug related reimbursement experience 
  • Medical reimbursement experience with Buy & Bill and/or Specialty Pharmacy.
  • Experience in the healthcare industry including, but not limited to insurance verification, prior authorizations, and/or claim adjudication, physician’s office or clinics.
  • Medicare and commercial insurance coverage experience.
  • Payor knowledge in AZ, NM, WA, CA, OR  (NOT A TRAVEL JOB, work here in Phoenix office)
  • Deliver and document benefit investigation outcomes and relay status reports on a regular basis.
  • Ability to effectively handle multiple priorities within a changing environment.
  • Strong Computer literacy
    • Must include PowerPoint
    • Must include Web Meeting experience

Feel free to email your resume to me directly at gloria.dambrisi@remx.com 

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