Help patients get access to life changing therapies without ever setting foot in a hospital or call center. As a Reimbursement Case Manager, you will be the main point of contact for patients and providers, making sense of benefits, prior authorizations, and assistance programs so treatment does not get stuck in paperwork.
About CareMetx
CareMetx partners with pharmaceutical, biotechnology, and medical device companies to support patients from first prescription through ongoing therapy. They provide hub services, technology, and data that simplify access, improve adherence, and remove barriers created by insurance and reimbursement. Their work sits at the intersection of healthcare, coverage, and patient advocacy.
Schedule
- Full time, remote role within the United States
- Must be flexible with schedule and hours
- Overtime may be required at times based on program demand
- Weekend work may be required to meet client and patient needs
What You’ll Do
- Act as the single point of contact for patients and providers, serving as a compassionate patient advocate on every interaction
- Coordinate access to therapies, conduct appropriate follow up, and connect patients with support services as needed
- Manage a caseload of patients based on program parameters and service expectations
- Collect and review patient information according to program SOPs, ensuring required data is complete and accurate
- Guide physician office staff and patients through completing and submitting program applications, including patient assistance and copay programs
- Determine patient eligibility and complete enrollment activities for support programs
- Perform reimbursement activities such as benefits investigations, prior authorizations, and appeals
- Provide reimbursement information and education to providers and patients
- Maintain frequent phone and email contact with patients, providers, payers, and pharmacies
- Deliver exceptional customer service, resolving requests in a timely and accurate manner and escalating complaints when needed
- Document all interactions and case activity in CareMetx systems in full compliance with HIPAA
- Report any Adverse Events in alignment with training and standard operating procedures
- Collaborate with internal teams to resolve issues and support smooth patient access
- Work within defined SOPs while exercising judgment on moderate complexity cases
What You Need
- Previous 3 or more years of experience in one or more of the following: specialty pharmacy, medical insurance, reimbursement hub, physician office, or healthcare setting
- Bachelor’s degree preferred
- Strong verbal and written communication skills with a patient first mindset
- Ability to manage multiple cases, tasks, and shifting priorities without losing details
- Proficient keyboard and computer skills, including MS Word and Excel
- Working knowledge of HIPAA regulations and comfort handling sensitive patient data
- General understanding of pharmacy and medical benefits; familiarity with commercial and government payers preferred
- Strong interpersonal skills and the ability to build rapport with patients and providers
- Solid problem solving skills and comfort reviewing multiple factors to decide next steps
- Ability to work independently and as part of a team in a fast paced environment
- Customer satisfaction focused with a calm, professional presence on the phone
Benefits
- Estimated salary range: about 38,418 to 51,224 dollars per year
- Fully remote position with the ability to impact patients nationwide
- Opportunity to grow your career in patient access, reimbursement, and specialty therapies
- Work in a mission driven environment that supports patients when insurance and cost become barriers
- Equal opportunity employer committed to an inclusive workplace
If you have reimbursement or specialty pharmacy experience and want your work to directly help patients start and stay on needed therapies, this is a strong fit to pursue.
Happy Hunting,
~Two Chicks…