Location: South San Francisco,
The Case Manager acts as a liaison between patients, providers, MDs, pharmacies and insurance carrier to assure services are provided in the least restrictive, least costly manner.
Provides customer focused reimbursement support to patients, pharmacists, physicians and internal sales force in a high volume contact center environment (both inbound and outbound phone calls)
Educates, informs, and assists patients and providers to navigate through the reimbursement process for the assigned product
Identifies barriers to reimbursement and continually identifies and recommends program efficiencies to the Supervisor to promote high quality of work by Access Solutions/GATCF staff
Identifies and facilitates referrals to alternative coverage options and financial assistance programs for patients who are under insured or require copy assistance
Establishes relationships with appropriate stakeholders
May conduct necessary benefits, coverage and payer research/investigations to ensure appropriate resources, compliance with payor appeal policies, practices, timelines,
Educates, informs and generally assists patients and their families, as well as other related external or internal parties on how to navigate the appeals process
Manages all steps, timing and outcomes during appeal process. Including completing written communications to patients and other external parties on appeal progress
Follows-up on all appeals to obtain, where possible, authorizations and ensure appropriate status
This position may require some travel and flexibility in work shift.
Please note that all candidates are required to take 3 assessments prior to being extended an offer for this position. Assessments will take about 90 minutes to complete.
If your candidate is a returning contractor and has taken the assessment in the last 2 years he/she will not need to retake the assessments. Please let PRO know if this is the case.
Understands reimbursement/funding resources and how to access these resources.
Demonstrates effective problem solving and excellent customer service.
Excellent investigational and analytical skills with a proven ability to communicate effectively in both written and verbal format.
Ability to work collaboratively in a team structure and responsibly delegates next steps to appropriate team members.
Ability to learn and apply
Must be able to work effectively under pressure and prioritize tasks.
Thrives in a metric-driven environment
Knowledge of the managed care industry preferred, including government payers.
Bachelor’s degree preferred
Job Type: Contract
Location: South San Francisco, CA
Job ID: 16-04584
Date Updated: July 4, 2019