A healthcare services organization is seeking experienced Reimbursement Case Managers to support patients and healthcare providers throughout the specialty medication access and reimbursement process.
This is a high-touch, phone-based case management role requiring frequent inbound AND outbound calls with patients, physician offices, healthcare providers, pharmacies, and insurance representatives.
Schedule: Monday-Friday, 11:00 AM-8:00 PM ET
Candidates must have previous experience working in a pharmaceutical patient services hub, reimbursement hub, specialty pharmacy, or closely related patient access environment.
This role requires individuals who are comfortable owning cases from intake through resolution/closure, rather than handling only one portion of the reimbursement process.
Key Responsibilities
• Manage an assigned caseload from initial intake through case resolution and closure.
• Handle a high volume of inbound and outbound phone calls with patients, providers, physician offices, pharmacies, and insurance representatives.
• Serve as a primary point of contact for patients and providers throughout the treatment access process.
• Speak directly with patients regarding access to prescribed therapies, available support programs, next steps, and case status.
• Communicate with provider offices regarding treatment access, required documentation, reimbursement requirements, and outstanding case needs.
• Conduct benefits investigations and verify medical and pharmacy coverage.
• Support prior authorizations, appeals, copay assistance, patient assistance programs, and other reimbursement activities.
• Educate patients and provider offices on required forms, documentation, enrollment requirements, and program processes.
• Proactively follow up on open cases to obtain missing information and move cases toward resolution.
• Determine patient eligibility for applicable assistance and support programs.
• Coordinate with insurance companies, pharmacies, provider offices, and internal teams to resolve access barriers.
• Maintain detailed and accurate documentation of all calls, case activity, status updates, and outcomes within the case management system.
• Identify and appropriately escalate complex cases, complaints, and access issues.
• Follow HIPAA requirements, program guidelines, SOPs, and adverse event reporting procedures.
• Deliver compassionate, professional service while managing sensitive patient and treatment-related conversations.
Required Qualifications
• 3+ years of relevant healthcare experience strongly preferred.
• Previous HUB experience is required, ideally within pharmaceutical patient services, reimbursement, specialty pharmacy, or patient access.
• Demonstrated experience communicating directly with both patients and healthcare providers regarding care, treatment access, reimbursement, or specialty medications.
• Experience managing cases through the full case lifecycle, including follow-up and case closure.
• Working knowledge of benefit investigations, prior authorizations, appeals, copay programs, patient assistance programs, and medical/pharmacy benefits.
• Comfortable spending a significant portion of the workday on the phone handling both inbound and outbound calls.
• Strong understanding of commercial and government insurance/payer processes.
• Excellent verbal communication, customer service, and patient advocacy skills.
• Strong documentation, organization, and follow-up skills.
• Ability to manage a caseload and multiple priorities in a fast-paced environment.
• Knowledge of HIPAA requirements and handling protected health information.
• Proficiency with Microsoft Office and healthcare/case management systems.
• Bachelor's degree preferred but not required with equivalent relevant experience.
Candidates must be able to consistently work the 11:00 AM-8:00 PM ET shift.
Ideal Candidate
The ideal candidate has worked in a pharmaceutical HUB or patient access program and understands what it means to own a patient case from beginning to end. You should be comfortable picking up the phone, making proactive outbound calls, receiving inbound calls, speaking directly with patients and provider offices, navigating reimbursement barriers, and following each case through to a clear resolution or closure.
#INDMSP