Case Manager I
825 Northeast Multnomah Street Portland, OR 97232
Our client is a leading biotechnology company that discovers, develops, manufactures and commercializes medicines to treat patients with serious or life-threatening medical conditions. They are among the world' s leading biotech companies, with multiple products on the market and a promising development pipeline.
- The Access Solutions Case Manager acts as a liaison between patients, providers, distributors, and insurance carriers to assure services are provided in the least restrictive and least costly manner.
- The Case Manager is an individual contributor and reports to the Access Solutions Supervisor.
- Provide reimbursement support to patients, pharmacists, physicians, and internal sales force.
- Educate, inform, and assist patients (and their families) and providers to navigate through the reimbursement and appeal process for the assigned product.
- Identify barriers to reimbursement and continually identify and recommend program efficiencies to the Supervisor to promote a high quality of work by Access Solutions staff.
- Identify and facilitate referrals to alternative coverage options and financial assistance programs for patients who are under insured or require copy assistance.
- Establish relationships with appropriate stakeholders including internal & external partners.
- May conduct benefits coverage and payer research/investigations to ensure appropriate resources, compliance with payer appeal policies, practices, and timelines.
- Periodic mandatory overtime throughout the year is required in Access Solutions Operations. This may include, but is not limited to, high referral season (Blizzard, Enrollment renewal), new product or system launches, new line extensions, or any unexpected surge in volume or backlog situations. May include weekends as needed.
- 3 years of reimbursement experience preferred.
- Knowledge of the managed care industry, including government payers.
- Proficient in all aspects of reimbursement (i.e., benefit investigations, payer reimbursement policies, regulatory and administrative rules).
- Understands reimbursement/funding resources and how to access these resources.
- Demonstrates effective problem-solving skills and provides excellent customer service.
- Excellent investigational and analytical skills with a proven ability to communicate effectively in both written and verbal format.
- Ability to work collaboratively in a team structure and responsibly delegate next steps to appropriate team members.
- Able to work effectively under pressure and prioritize tasks.
- Able to follow written Standard Operating Procedure.
- Inspiring and Influencing
- Teamwork and Collaboration
- Achieving Results
- Bachelor’s degree is preferred.