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Reimbursement Case Manager

Job Locations US-NC-Morrisville
Posted Date 3 days ago(3/11/2025 12:31 PM)
ID
2025-5759
# of Openings
5
Category
Market Access

Overview

Mercalis is an integrated life sciences commercialization partner that provides comprehensive solutions that span the entire healthcare value chain. Backed by proven industry expertise and results-driven technology, Mercalis helps navigate the complex life sciences marketplace by providing commercialization solutions to accelerate value and enhance patient lives.

 

Mercalis fosters a culture that encourages individuality and provides opportunities for creativity, growth, and success while fostering a team environment. We are a diversity-driven organization with an inclusive approach to delivering patient-centric solutions that, eliminate barriers for patients, and increase patient access to life altering medications.

 

As a Reimbursement Case Manager, you provide inbound and outbound phone support and serve as the primary contact for patients, caregivers, and providers.  You will facilitate a collaborative process that gauges, coordinates, and monitors patient needs and appropriately facilitate a patient’s journey utilizing services offered through the Patient Support Program on behalf of a manufacturer.  The primary function is to provide unparalleled customer service to patients, caregivers and providers as a dedicated contact by coordinating resources, exchanging information and ensuring appropriate delivery of services. These services include handling the day-to-day activities within reimbursement services, such as daily interactions with healthcare insurance companies to verify the financial aspects of healthcare services to ensure patients have access to life saving treatments they need.

Responsibilities

 

  • Reimbursement Case Managers may be regionally aligned and will serve as an expert on reimbursement, co-pay, foundation assistance, PAP issues, and other forms of available support and will be responsible for handling patient and healthcare provider interactions
  • Serve as an advocate to patients regarding eligibility requirements, program enrollment, reimbursement process, affordability support, and general access for prescribed therapy
  • Establish relationships, develop trust, and maintain rapport with patients, payers and healthcare providers
  • Serve as direct point of contact to health care providers for ongoing support and relationship development by acquiring and delivering detailed information regarding a program and/or a patient
  • Serve as a resource for patients and healthcare professionals to verify insurance coverage, medical billing, reimbursement process, and general access for complex pharmaceuticals
  • Evaluate program enrollment forms for data integrity
  • Responsible for insurance benefit investigations, and triage cases according to program standard operating procedures
  • Follow program guidelines and escalate complex cases according to program policy, SOPs, Call Guides, and other program materials.
  • Working case management system, documenting status/background in case notes, communicating patient benefits, assisting in the PA/Appeals process and like responsibilities
  • ·       Ability to understand and explain benefits offered by all payer types including private/commercial and government (i.e., Medicare, Medicaid, VA and DOD)
  • ·       Act as an assigned liaison to client contacts (e.g., regional contact for sales representatives), Program Management, other internal stakeholders and Healthcare Providers
  • Maintain records in accordance with applicable standards and regulations to the programs/promotions
  • ·       Provide unparalleled customer service while serving as a brand advocate and program representative; understands the importance of achieving quality outcomes and commit to the appropriate use of resources
  • Works with the Program Manager, on a day-to-day basis to maintain open lines of communication and share awareness regarding patient status, prescriber feedback/satisfaction and program effectiveness
  • Understand health and disease states of patients of the programs
  • Maintains a high level of ethical conduct regarding confidentiality and privacy
  • Help maintain team morale by consistently demonstrating positive attitude
  • ·       On time adherence to training deadlines for all corporate policies and procedures governing access to confidential data
  • ·       Ensure all SOPs are followed with consistency
  • ·       Conducts miscellaneous tasks or projects as assigned Identify and report pharmacovigilance information as required by client(s) (i.e., Adverse Events) – (specific to program/client requirements)

Qualifications

  • Associate or Bachelor’s degree preferred; or a minimum of 4 years of call center or customer service experience with progressive levels of responsibility within a service driven environment
  • Ability to communicate effectively both orally and in writing
  • Knowledge of medical insurance terminology and reimbursement/insurance, healthcare billing, physician office, health insurance processing or related experience
  • Excellent problem-solving and decision-making skills required
  • Attention to detail and committed follow through in communication with patients, providers and internal stakeholders
  • Strong organizational skills
  • Willing to work in a dynamic, fast paced environment and have the ability to multi-task and adapt to change while adhering to Program Standards
  • Strong interpersonal skills, ability to work both independently and as part of a team,ability to jump in and help others as needed
  • Empathetic listening skills in order to interact effectively with patients and providers
  • Punctual, reliable with strong attendance record
  • Proficient with Microsoft products

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