Case Manager I
1 DNA Way South San Francisco, CA 94080
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 Case Manager acts as a liaison between patients, providers, MDs, distributors and insurance carrier to assure services are provided in the least restrictive and least costly manner.
- Provides customer focused reimbursement support to patients, pharmacists, physicians and internal sales force
- Educates, informs, and assists patients and providers to navigate through the reimbursement process for the assigned product
- Identifies barriers to reimbursement and continually identifies and recommends program efficiencies to the Supervisor to promote high quality of work by Access Solutions/GATCF staff
- Identifies and facilitates referrals to alternative coverage options and financial assistance programs for patients who are under insured or require copy assistance
- Establishes relationships with appropriate stakeholders including internal & external partners
- May conduct necessary benefits, coverage and payer research/investigations to ensure appropriate resources, compliance with payer appeal policies, practices, timelines
- Educates, informs and generally assists patients and their families, as well as other related external or internal parties on how to navigate the appeals process
- This position may require some travel and flexibility in work shift
- 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, enrollment renewals, new line extensions, or any unexpected surge in volume or backlog situations.
- Workdays are M-F, but may include weekends as needed.
The successful candidate will demonstrate the following competencies critical to this role:
- Communication – Listens well; expresses ideas fluently and logically; is open to input and can be depended on for truthfulness
- Inspiring and Influencing – Fosters an exchange of ideas and support; persuades and influences without authority
- Teamwork and Collaboration – Creates atmosphere of openness and truest’ collaborates; offers support and encouragement
- Achieving Results – Is goal directed and persistent; is accountable for meeting commitments; recognizes the contributions of peers
- Bachelors degree is preferred
- A minimum of 3 years of reimbursement experience preferred
- 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 delegates next steps to appropriate team members.
- Must be able to work effectively under pressure and prioritize tasks.
- Must be able to follow written Standard Operating Procedure
- Candidate must have excellent knowledge of the managed care industry, including government payers.