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Reimbursement Case Manager
Vanscoy Rare Pharmacy. Serve as primary point of contact and case manager for client and customer inquiries and escalations .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in pharmacy reimbursement processes, case management, and patient access solutions, while providing exceptional customer service and maintaining compliance with patient privacy laws.
Highest-signal resume keywords
Pharmacy Reimbursement ExperienceCase Management ExperienceBenefit Investigation and VerificationCareTend Pharmacy Management SystemCommunication 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
Pharmacy Case ManagementBenefits InvestigationBenefits VerificationPrior Authorization ProcessPharmacy Access Support SolutionsInsurance Structures KnowledgeCo-Pay Assistance KnowledgeDocumentation SkillsTraining Material CreationPatient Claims Management
Soft Skills
Customer ServiceTime ManagementIndependent Decision MakingCollaborationProblem Solving
Tools & Technologies
Microsoft ExcelMicrosoft OutlookMicrosoft WordCareTend Pharmacy Management System
Industry Keywords
Pharmacy BenefitsPayer TrendsSpecialty Pharma MarketMedicaidCommercial PlansFederal Plan TypesRare DiseasesPatient Privacy LawsThird-Party ProgramsFoundation Programs
About the role
Key responsibilities & impact- Serve as primary point of contact and case manager for client and customer inquiries and escalations
- Process benefits investigations, benefits verifications, prior authorization submissions, and appeals
- Coordinate services with internal program operations and Program Management
- Collaborate with manufacturer representatives, HCP offices, and other key personnel on complex cases
- Manage patient claims for prescription drug and medical benefits
- Establish regional expertise on payer trends, product access, and reimbursement trends or delays
- Complete program enrollment, answer inquiries, and coordinate access to therapies according to SOPs and service levels
- Process patient and prescriber requests to ensure timely therapy access
- Research cases independently and make sound decisions using professional judgment
- Maintain frequent phone contact with internal staff, external clients, and specialty pharmacies
- Provide exceptional customer service and resolve or appropriately escalate requests
- Support efficient referral processing from intake through prescription triage
- Resolve complex pharmacy reimbursement and patient support issues
- Maintain compliance with patient privacy laws and collaborative internal/external relationships
- Report to the Clinical Pharmacist and Implementation Manager
Requirements
What you’ll need- High school diploma or equivalent
- 2+ years of relevant pharmacy reimbursement/insurance experience, including benefit investigation and benefit verification of prescription benefits
- 2+ years of relevant pharmacy case management experience
- 1+ years of experience as a pharmacy technician
- 1+ years of experience operating in CareTend Pharmacy Management System
- Working knowledge of BI/BV process, pharmacy and prescription benefits, prior authorization process, and pharmacy access support solutions
- Ability to communicate in a clear, logical, effective, and consistent manner
- Ability to independently manage case load, prioritize work, and use time management skills to manage deliverables
- Ability to reliably access required systems and software while telecommuting
- Preferred: Associate’s Degree or Bachelor’s Degree
- Preferred understanding of government, commercial, Medicaid, VA, and Federal plan types
- Preferred understanding of biologic/specialty pharma market and patient access challenges
- Preferred knowledge of insurance structures, PBMs, major medical plans, and co-pay assistance cards
- Preferred working knowledge of third-party and foundation programs
- Preferred basic understanding of co-pay assistance
- Preferred proficiency with Microsoft Excel, Outlook, and Word
- Preferred knowledge of rare diseases
- Preferred experience documenting requirements, creating training materials, and working directly with end users
Benefits
Comp & perks- Teleworking from the employee’s home address, contingent upon business needs
- Employee-set-up home office environment
- Reasonable accommodations for individuals with disabilities