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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in case management and patient communication, ensuring timely processing of prior authorizations and appeals while adhering to quality standards. Proficient in medical terminology and claims processing, with strong critical thinking and multitasking abilities.
Highest-signal resume keywords
Pharmacy Benefit Management ExperiencePrior Authorization ProcessingMedical Terminology KnowledgeExcellent Written/Verbal CommunicationCritical Thinking Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Case ManagementQuality ChecksAdverse Drug Event ReportingClaims ProcessingPatient AssessmentTroubleshooting Complex CasesMulti-tasking
Soft Skills
CommunicationCoordinationProblem-solving
Tools & Technologies
MicroSoft Office Applications
Certifications & Qualifications
Medical Assistant CertificationSocial Worker CertificationSenior Reimbursement Specialist Certification
Industry Keywords
Patient BenefitsReimbursementHealthcare ProvidersField Reimbursement RepresentativesQuality StandardsSafety and Environmental Programs
About the role
Key responsibilities & impact- Provide day-to-day oversight and coordination of assigned caseload
- Ensure case elements and tasks are completed timely and cases move through the process as required
- Act as the single point of contact for prior authorization and appeal processing communications
- Communicate patient benefits and responsibility to patients, healthcare providers, field reimbursement representatives and other external stakeholders
- Assess and refer patients appropriately for special programs and services
- Perform quality checks on cases and report trends to leadership
- Adhere to quality and production standards and applicable company, state and federal safety and environmental programs and procedures
- Troubleshoot complex cases across multiple disease states while interfacing with internal and external stakeholders
- Report Adverse Drug Events experienced by patients according to pharmaceutical requirements
- Recognize product quality complaints and forward caller or written information to a manufacturer
- Perform other duties as assigned
Requirements
What you’ll need- Bachelor’s degree or six years of relevant working experience
- Two (2) or more years of relevant experience in pharmacy benefit management preferred
- Medical Assistant, Social Worker or Senior Reimbursement Specialist experience preferred
- Certification preferred but not required
- Proficient in MicroSoft Office applications
- Knowledge of medical and claims processing terminology
- Excellent written/verbal communication to include providing clear instructions
- Must possess a strong critical thinking skillset along with the ability to multi-task
- M-F 8AM - 4:30PM ET with rotating shift coverage for program hours of M-F 8AM-8PM ET
Benefits
Comp & perks- Remote opportunities
- Competitive salaries
- Growth opportunities for promotion
- 401K with company match
- Tuition reimbursement
- Flexible work environment
- 20 Days PTO (Paid Time Off)
- Paid Holidays
- Employee assistance programs
- Medical, Dental, and vision coverage
- HSA/FSA
- Telemedicine (Virtual doctor appointments)
- Wellness program
- Adoption assistance
- Short term disability
- Long term disability
- Life insurance
- Discount programs