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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in pharmacy benefit management and patient support services, with a strong focus on prior authorization, appeals processing, and effective communication with stakeholders. Proven ability to mentor teams and improve operational processes while ensuring compliance with pharmaceutical requirements.
Highest-signal resume keywords
Pharmacy Benefit ManagementPrior Authorization ProcessingPatient AdvocacyMedical Benefit VerificationCritical 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
Prior AuthorizationAppeals ProcessingMedical TerminologyClaims ProcessingQuality Checks
Soft Skills
Excellent CommunicationMulti-taskingMentoringCollaborationProblem Solving
Tools & Technologies
Microsoft Office
Certifications & Qualifications
Medical AssistantSocial WorkerSenior Reimbursement Specialist
Industry Keywords
Patient Support ServicesSpecialty PharmacyHUB ServicesAdverse Drug EventsProduct Quality Complaints
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
- Coordinate prior authorization, reauthorization, and appeal processing communications
- Serve as a patient advocate and resource during the reimbursement process
- Coordinate additional patient access services within program guidelines
- Perform quality checks and report trends to leadership
- Troubleshoot complex cases across multiple disease states
- Interface with internal and external stakeholders to support timely therapy starts
- Report Adverse Drug Events according to pharmaceutical requirements
- Recognize product quality complaints and forward information to the manufacturer
- Support case managers with prior authorization and appeal requirements
- Provide guidance, answer process questions, and address escalated issues
- Support at-risk patients and prescribers to mitigate therapy delays or interruptions
- Collaborate with senior case managers, managers, and the quality team on quality trends and process improvement
- Prepare and present team huddles and client presentations, with a minimum of one presentation per month
- Mentor or lead case managers and help ensure smooth operations
- Perform other duties as assigned
Requirements
What you’ll need- Bachelor’s degree or six years of relevant working experience
- Five (5) or more years of relevant experience in pharmacy benefit management, specialty pharmacy or patient support/access (HUB) services preferred
- Three (3) or more years of relevant experience in pharmacy and/or medical benefit verifications, prior authorization and/or appeals required
- Medical Assistant, Social Worker or Senior Reimbursement Specialist experience preferred
- 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
- Must be able to work 11am-8pm EST
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