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Must be able to work any 8-hour shift between 7AM-7PM (CST); Monday–Friday.
Job Description
Monitor system accounts for new patient cases.
Conduct outbound calls to patients to confirm approval / denials of coverage, co-pays, and verification of specialty pharmacies dispensing medication(s).
Contact insurance companies as required to obtain / enter accurate benefit information related to patient coverage.
Meditate effective resolution for complex payer / pharmacy issues toward a positive outcome.
Maintain quality while providing an empathetic and supportive experience to patients, providers, and physician offices.
Resolve patient's questions and concerns regarding the status of their request for assistance.
Enter detailed information into company proprietary software while conversing via telephone.
Steward patient accounts from initial contact through final approval / denial.
Process all patient applications in accordance with set policy, procedures, and PHI compliance.
Work with / provide updates to team members and leadership on patients’ cases.
Identify, document, and compliantly submit adverse events during customer contact or via received documentation.
Conduct research associated with alternative funding / foundations to determine patient eligibility to receive product.
Effectively apply knowledge of job and company policies and procedures to complete a variety of assignments.
Apply advanced skills to resolve complex problems independently.
Work independently within established procedures.
Critical Information
All U.S. residents are eligible to apply for this position.
Remote work requires a dedicated, quiet, private, distraction-free environment with access to high-speed internet.
Inability to meet internet requirements may result in termination of the contract / employment.
Education / Licenses Needed
Minimum of HS diploma; additional education preferred.
Previous healthcare experience with insurance or in the pharmaceutical industry preferred.
Pharmacy benefits management experience preferred with knowledge of Medicare, Medicaid, and commercially insured payer common practices and policies.
Previous prior authorization and appeals experience highly desired.
Benefits :
Benefits are available to full-time employees after 90 days of employment.
A 401(k) with a company match is available to full-time employees with 1 year of service on our eligibility dates.
This is an AI-Formatted job description; therefore, this does not remove human decision-making.
PandoLogic. Keywords : Medical Case Manager, Location : Lewisville, TX - 75029 , PL : 599980956