If you know your way around benefit investigations, prior auths, and payer calls, this role keeps you right in the middle of the patient journey. You’ll help providers and patients navigate coverage, get the right paperwork submitted, and keep prior authorizations moving without delays.
About CareMetx
CareMetx supports patients from intake to outcomes through hub services, technology, and data that help pharma, biotech, and medical device innovators deliver care. Their work plays a direct role in getting specialty products and devices to the patients who need them, especially when reimbursement is complicated.
Schedule
- Remote
- Must be flexible on schedule and hours
- Overtime may be required at times
- Weekend work may be required based on business needs
What You’ll Do
⦁ Collect and review patient insurance benefits information in line with program SOPs
⦁ Support physician offices and patients with completing and submitting insurance forms and program applications
⦁ Submit prior authorization forms to third-party payors and track follow-ups to keep requests moving
⦁ Respond to provider account inquiries and accurately document all interactions in the CareMetx Connect system
⦁ Provide strong customer service, resolve requests quickly, and escalate issues or complaints appropriately
⦁ Maintain frequent phone contact with providers, payor reps, and pharmacy staff
⦁ Identify and report reimbursement trends or delays to leadership
⦁ Process insurance and patient correspondence as needed
⦁ Gather documentation required for prior auths (demographics, referrals, NPI, referring physician details, etc.)
⦁ Coordinate with internal teams to resolve issues and support program execution
⦁ Communicate effectively with payors to ensure accurate, timely benefit investigations
⦁ Report adverse events (AEs) in alignment with training and SOPs
What You Need
⦁ High school diploma or GED
⦁ 1+ year of experience in specialty pharmacy, medical insurance, physician office, healthcare, or related setting
⦁ Strong verbal and written communication skills
⦁ Ability to build productive relationships with internal and external partners
⦁ Strong organization, attention to detail, and time management
⦁ Comfort problem-solving within defined SOPs and exercising sound judgment
⦁ Working knowledge of pharmacy and medical benefits (commercial and government payers preferred)
⦁ Proficiency with Microsoft Excel, Outlook, and Word
⦁ Ability to work independently and as part of a team, with a customer-first mindset
Benefits
⦁ Salary range: $30,490.45 – $38,960.02
⦁ Remote work environment
⦁ Equal opportunity employer
⦁ Mission-driven work supporting patients who need specialty products and devices
If you’re ready to help patients get access to care by keeping reimbursement processes tight and moving, apply while it’s open.
Be the difference between “denied” and “approved.”
Happy Hunting,
~Two Chicks…