Role & seniority: Care Manager (Remote); duties vary by program lifecycle

Stack/tools: Inbound/outbound calling; payer/insurance portals; benefit investigations; prior authorization systems; enrollment for copay assistance programs; medical billing processes

Top 3 responsibilities

Serve as single point of contact for providers and patients in a designated area
Contact insurers to perform benefit investigations and verify coverage/eligibility
Assist with prior authorizations and enrollment in patient assistance programs; support enrollment for manufacturer/non-profit copay programs

Must-have skills

Strong communication with patients, providers, and internal teams
Attention to detail and accuracy in benefit investigations and documentation
Understanding of medical billing processes and eligibility requirements
Ability to work independently and in a team; adhere to standards/guidelines

Nice-to-haves

Experience with medical billing reimbursement support and provider communications
Familiarity with payer portals, authorization workflows, and patient assistance programs
Remote-work experience; comfort with educational/training activities
Location & work type: Fully remote; temporary role with benefits eligibility dependent on classification/time employed

Full Description

Description

Position Summary

Care Manager responsibilities will vary by program and its lifecycle. Care Manager’s may be responsible for contacting insurance companies to obtain correct eligibility information, perform benefit investigations, copay assistance and check prior authorization and/or appeal status. Care managers may also be responsible for directly contacting patients and/or providers to evaluate eligibility for assistance programs and/or varied adherence support. This is a remote position.
The information contained herein is intended to be an accurate reflection of the duties and responsibilities of the individuals assigned to this position. They are not intended to be an exhaustive list of the skills and abilities required to do the job. AllCare Plus Pharmacy reserves the right to revise the job or to require that other or different tasks be performed as assigned.

Primary Responsibilities

Responsible for all inbound and outbound phone calls to patients and providers.

Responsible for single point of contact communication with providers and patients in a designated geographical area
Contact insurance companies to perform appropriate benefit investigation(s) and coverage eligibility for client product only
If applicable, assist with the prior authorizations with specific attention to detail and accuracy with provided information.
Assist patients with the enrollment process for manufacturer and non-profit organization copay assistance programs
Provide courteous, friendly, professional and efficient service to internal and external customers including physicians and patients.
Update job knowledge by participating in educational opportunities and training activities
Work efficiently both individually and within a team to accomplish required tasks
Maintain and improve quality results by adhering to standards and guidelines and recommending improved procedures
Eligibility authorization and enrollment into Patient Assistance Program(s)
Ability to verify insurance requirements to support current billing processes
Demonstrate a firm grasp of medical billing processes communicating knowledge to internal and external customers
Identifying and providing corrective action for medical billing reimbursement support specifically to provider offices

Pay and Benefits
The pay range for this position is $21.00 - $21.00/hr.

Remote Benefit Verification/Case Manager