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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 oversight, ensuring timely processing and communication with patients and healthcare providers. Proficient in benefits investigation and knowledgeable in medical terminology, with strong critical thinking and multi-tasking abilities.
Highest-signal resume keywords
Case Management OversightPharmacy Benefit ManagementBenefits InvestigationExcellent Communication SkillsCritical Thinking
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 CoordinationQuality ChecksPre-ScreeningPayer Information ManagementAdverse Drug Event Reporting
Soft Skills
Multi-TaskingTroubleshooting
Tools & Technologies
MicroSoft OfficeSalesforce
Industry Keywords
Medical TerminologyClaims ProcessingPatient Assistance ProgramsCo-Pay MitigationInjection Services
About the role
Key responsibilities & impact- Provide day-to-day case management 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 with patients, healthcare providers, field reimbursement representatives, and other external stakeholders
- Communicate patient benefits and responsibility accurately and timely
- Assess and refer patients for special programs/services when appropriate
- Perform quality checks on cases and report trends to leadership
- Troubleshoot complex cases spanning multiple disease states
- Interface with internal and external stakeholders to ensure optimal start to therapy
- Complete pre-screening to determine eligibility for injection services, co-pay mitigation, and patient assistance programs when applicable
- Maintain accurate payer information and patient status documentation
- 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
- Experience in full benefits investigation
- PAP experience is 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
- Strong critical thinking skillset
- Ability to multi-task
- Salesforce experience preferred
- Must comply with applicable company, state and federal safety and environmental programs and procedures
- Must report Adverse Drug Events in accordance with pharmaceutical requirements
- Must recognize product quality complaints and forward caller/written information to a manufacturer
Benefits
Comp & perks- Remote opportunities
- Growth opportunities for promotion
- 401K with company match
- Tuition reimbursement
- Flexible work environment
- 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 program