The Case Manager/Prior Authorizations Rep is an integral part of the Patient Services team, responsible for the coordination and delivery of services related to the patient support programs. The role involves interactions with patients, physicians and other health care professionals (HCPs) as well as members of client's team using web-based, telephony and face-to-face means of communication. The role involves understanding and adherence to corporate, divisional, departmental and program-specific standard operating procedures.
- Review, analyze and validate information provided by patients and HCPs for accuracy and completeness to ensure initiation of services
- Follow the program protocols to ensure that the most appropriate next step is scheduled to ensure continuity of service delivery to HCPs and patients
- Process data entry activities of pertinent information received at different points of contact during the delivery of program services
- Provide answers to general inquiry calls submitted via telephone or web-based platforms on program services, disease state or product-related questions, based on information provided as part of the program materials
- Perform surveys on patients and other program users, based on documentation provided, and perform data entry activities on information received
- Conduct reimbursement investigations with private and public reimbursement providers
- Participate in reimbursement or other program-related research activities, as assigned by the Program Manager and/or Departmental Manager
- Coordinate/facilitate submission of Special Authorization letters to public and private payers
- Conduct reimbursement denial escalations through employers/payers
- Gather information and conduct patient financial assessment eligibility based on program guidelines
- Request financial transactions to be processed based on communicated program guidelines
- Gather pertinent information, and coordinate patient’s access to services as well as conduct follow-up activities
RemX is the professional staffing division of EmployBridge. RemX focuses on the placement of Contact Center, Accounting & Financial, IT, Engineering, and Administrative Professionals, across the U.S. We understand the importance of finding the right person for the right job in the right environment.
Role: Medical Benefit Specialist
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