Case Manager#26-20887 Lewisville, TX

Onsite Job Description Responsibilities:

Receive inbound and outbound calls from patients, healthcare provider offices, SPs, and customers, striving for one-call resolution Manage the entire care process with a sense of urgency from benefit investigation/verification to medication delivery, ensuring an exceptional patient experience Conduct benefit verifications and collaborate with various healthcare providers, including physicians, specialty pharmacies, and insurance companies, to ensure seamless coordination of patient care and timely access to necessary services Assist in obtaining insurance, prior authorization, and appeal requirements and outcomes Help patients understand their insurance plan coverage, including out-of-pocket costs, and provide guidance on the appeals process if needed Resolve patient's questions and any representative for the patient's concerns regarding status of their request for assistance Demonstrate expertise in payer landscapes and insurance processes. Remain knowledgeable about long and short-range changes in the reimbursement environment including Medicare, Medicaid, Managed Care, and Commercial medical and pharmacy plans while planning for various scenarios that may impact prescribed products Process enrollments via fax, phone, and electronically as needed Scrutinize forms and supporting documentation thoroughly for any missing information or new information to be added to the database

Qualifications:

2-4 years of industry experience with patient-facing or high touch customer interaction experience preferred Previous Hub or Patient Support Service experience preferred High School diploma or equivalent preferred Knowledge of Medicare (A, B, C, D), Medicaid & Commercial payers policies and guidelines for coverage, preferred Strong people skills that demonstrate flexibility, persistence, creativity, empathy, and trust. Robust computer literacy skills including data entry and MS Office-based software programs Strong understanding of pharmaceutical therapies, disease states, and medication adherence challenges preferred Excellent written and oral communication, mediation, and problem-solving skills, including the ability to connect with patients, caregivers, and providers What is expected of you and others at this level: Effectively applies knowledge of job and company policies and procedures to complete a variety of assignments In-depth knowledge in technical or specialty area Applies advanced skills to resolve complex problems independently May modify process to resolve situations Works independently within established procedures; may receive general guidance on new assignments May provide general guidance or technical assistance to less experienced team members

TRAINING AND WORK SCHEDULES

Your new hire training will take place 8:00am-5:00pm CST, mandatory attendance is required. This position is full-time (40 hours/week). Employees are required to have flexibility to work any of our shift schedules during our normal business hours of Monday-Friday, 7:00am- 8:00pm CST.

REMOTE DETAILS

You will work remotely, full-time. It will require a dedicated, quiet, private, distraction free environment with access to high-speed internet. We will provide you with the computer, technology and equipment needed to successfully perform your job. You will be responsible for providing high-speed internet.

Internet requirements include the following:

Maintain a secure, high-speed, broadband internet connection (DSL, Cable, or Fiber) at the remote location. Dial-up, satellite, WIFI, Cellular connections are NOT acceptable. Download speed of 15Mbps (megabyte per second) Upload speed of 5Mbps (megabyte per second) Ping Rate Maximum of 30ms (milliseconds) Hardwired to the router Surge protector with Network Line Protection for CAH issued equipment

EEO:

"Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of - Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans."