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Case Manager
TEKsystems. Provide expertise on insurance coverage and common access and reimbursement challenges affecting patients, healthcare providers and clients .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in insurance coverage, patient access, and reimbursement processes while ensuring compliance with relevant laws and industry standards. Provides personalized case management and education to patients and healthcare providers, fostering trusted relationships and effective communication.
Highest-signal resume keywords
Healthcare Access DeliveryInsurance ReimbursementPatient EducationMedical TerminologyHIPAA Compliance
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Insurance ProcessesCoding SystemsICD-10CPTHCPCSBenefits InvestigationCase ManagementPatient AccessReimbursement ChallengesProgram Eligibility
Soft Skills
Relationship BuildingCommunicationProblem SolvingCollaborationEmpathy
Tools & Technologies
Reimbursement Support ToolsPatient Access ProgramsCall Management Systems
Certifications & Qualifications
PACSCHESCCM
Industry Keywords
Healthcare AdministrationPatient CareComplianceRegulationsIndustry Standards
About the role
Key responsibilities & impact- Provide expertise on insurance coverage and common access and reimbursement challenges affecting patients, healthcare providers and clients
- Educate patients, healthcare providers and clients on Valeris access and reimbursement support tools and participating programs
- Advise HCPs, patients and caregivers on benefits and program eligibility for specific patients
- Educate HCP offices on payer processes and procedures
- Build trusted relationships with patients, prescribers and client stakeholders regarding reimbursement inquiries and challenges
- Manage relationships in compliance with relevant laws, regulations, program procedures and industry standards
- Support inbound and outbound calls to patients, caregivers, specialty pharmacies and healthcare professionals
- Perform post-Benefits Investigation calls explaining coverage options and next steps
- Manage client inquiries, including case-specific statuses
- Manage HCP inquiries pursuant to business rules
- Ensure communications with client field teams comply with agreed ways-of-working protocols
- Manage inbound calls according to program-approved FAQs
- Triage patients to internal or external resources
- Provide personalized case management to patients and HCPs through outbound communications
Requirements
What you’ll need- Completion of Bachelor's degree (or higher) required
- A degree in healthcare administration, social science or similar related fields is strongly preferred
- Minimum two years of experience in healthcare access delivery or management is strongly preferred
- 5-10 years of experience in insurance reimbursement, patient access, direct patient care, and/or patient education experience will be considered in lieu of degree
- Other certifications and five or more consecutive years of experience in a relevant field may be considered
- Certification examples include PACS (Prior Authorization Certified Specialist), CHES (Certified Health Education Specialist) or CCM in healthcare or social science (Certified Case Manager)
- Strong understanding of medical terminology, coding systems (ICD-10, CPT, HCPCS), and insurance processes
- Ability to comply with relevant laws, regulations, program-specific operating procedures and industry standards, including HIPAA and insurance guidelines
- Ability to support inbound and outbound calls to patients, caregivers, specialty pharmacies and healthcare professionals
Benefits
Comp & perks- Medical, dental & vision
- Critical Illness, Accident, and Hospital
- 401(k) Retirement Plan with pre-tax and Roth post-tax contributions
- Life Insurance (Voluntary Life & AD&D for the employee and dependents)
- Short and long-term disability
- Health Spending Account (HSA)
- Transportation benefits
- Employee Assistance Program
- Time Off/Leave (PTO, Vacation or Sick Leave)