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Healthcare Case Manager

2 months ago

Dallas, United States CornerStone Staffing Full time

Are you an established Case Manager looking for your next exciting opportunity? Embark on a career with a specialized company that plays a crucial role in delivering unique products and devices to patients in need. This involves managing reimbursements, finding alternative funding when insurers fall short, and offering clinical services. If you have 3 years of healthcare case management experience, apply today

Job Title: Reimbursement Case Managers

Location: FULLY REMOTE (equipment will be provided)

  • Candidates must reside in Texas, Florida or North Carolina in order to be considered for this role

Pay: $20.00 - $23.00/hr (based on experience)

Schedule: 8 hour shift between 7am - 7pm CST / 8am - 8pm EST

Job Description:

Reimbursement Case Manager handles customer service and case management. They will interact with patients, healthcare providers, pharmacies, and manufacturer clients, supporting reimbursement and patient assistance tasks. The Reimbursement Case Manager answers all patient and provider inquiries and documents all interactions in the client system, ensuring HIPAA compliance.

Role Responsibilities:

  • Acts as a single point of contact for all providers and patients

  • Works as a patient advocate, demonstrating compassion

  • Enhances caller/contact experience

  • Coordinates access to therapies and follow-up support services

  • Manages case load based on program parameters

  • Collects and reviews patient information as authorized by SOP

  • Validates completeness of required information and assists providers/patients

  • Guides physician office staff and patients on application completion and submission

  • Determines patient eligibility and conducts enrollment activities (e.g., patient assistance programs, copay assistance)

  • Performs reimbursement activities (benefit investigations, prior authorizations, appeals)

  • Provides exceptional customer service, resolving requests timely and escalating complaints when needed

  • Maintains frequent phone contact with patients, provider representatives, third-party customer service, and pharmacy staff

  • Provides reimbursement information to providers/patients

  • Reports all Adverse Events (AE) as per training and SOP

  • Coordinates with inter-departmental associates as necessary

  • Works on problems requiring analysis of various factors

  • Exercises judgment within SOP to determine appropriate actions

  • Receives minimal instruction on day-to-day work, general instructions on new assignments

  • Extensive knowledge of HIPAA regulations and adherence to company policies

  • Performs related duties as assigned

Required Experience and Education:

  • Preferred 3+ years of experience in:

  • Specialty pharmacy

  • Medical insurance

  • Reimbursement hub

  • Physician’s office

  • Healthcare setting

  • Insurance background

  • Bachelor’s Degree preferred

Required Skills, Knowledge, and Abilities:

  • Excellent verbal and written communication skills

  • Ability to multi-task and adapt to changing priorities

  • Proficient keyboard skills

  • Competent in MS Word and Excel

  • Knowledge of HIPAA regulations

  • Detail-oriented and highly organized

  • Knowledge of pharmacy and medical benefits

  • Understanding of commercial and government payers (preferred)

  • Ability and initiative to work independently or as a team member

  • Strong problem-solving skills

  • Focused on customer satisfaction

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