Case Manager, Reimbursement

Job Summary

Providing day-to-day case management oversight, the remote Case Manager, Reimbursement will ensure timely completion of prior authorizations, reauthorizations, and appeals while acting as a primary resource for patients and healthcare providers.

Key responsibilities

• Coordinate and oversee caseload to ensure all tasks are completed in a timely manner
• Serve as the main point of contact for prior authorization and appeal processing communications
• Perform quality checks on cases and report trends to leadership

Required qualifications

• Bachelor's degree or six years of relevant working experience
• Two or more years of relevant experience in pharmacy benefit management
• Experience in full benefits investigation; PAP experience preferred
• Proficiency in Microsoft Office applications
• Knowledge of medical and claims processing terminology