Shifts available for these roles are:
2: 8:30 AM – 5:30 PM2: 9:30 AM – 6:30 PM2: 10:00 AM – 7:00 PM2: 11:00 AM – 8:00 PM

Mercalis is a leading integrated commercialization partner for the life sciences industry, offering end-to-end solutions across the healthcare value chain. With a strong foundation in industry expertise and results-oriented technology, Mercalis helps clients navigate the complexities of the life sciences marketplace by delivering commercialization strategies that accelerate value and improve patient outcomes.

Mercalis embraces a culture that values individuality, fosters creativity, and promotes professional growth within a collaborative team environment. As a diversity-focused organization, we are committed to an inclusive, patient-centric approach that removes access barriers and connects patients to life-changing therapies.

As a Reimbursement Case Manager, you will serve as the primary point of contact for patients, caregivers, and healthcare providers through both inbound and outbound phone communication. In this role, you will support a collaborative process that identifies, coordinates, and monitors patient needs while facilitating their access to therapy through services offered by the Patient Support Program on behalf of our pharmaceutical clients.

Your core responsibility is to deliver exceptional customer service by guiding patients through the reimbursement process. This includes verifying insurance benefits, coordinating access to financial support resources, and ensuring the timely and accurate delivery of program services. You will play a critical role in helping patients overcome coverage and affordability challenges, enabling access to the life-saving treatments they need.

• Reimbursement Case Managers (RCMs) are responsible for supporting patient access to therapy by navigating the reimbursement landscape, providing ongoing case management, and ensuring a seamless experience for both patients and healthcare providers.

• May be regionally aligned and serve as subject matter experts in insurance verification, affordability support, co-pay assistance, foundation and PAP resources, and other reimbursement-related matters.

• Conduct comprehensive insurance benefit investigations (BIs), including verification of both medical and pharmacy benefits.

• Understand and communicate benefit structures across all payer types, including Commercial, Medicare, Medicaid, VA, and DoD.

• Triage cases based on program SOPs and escalate complex issues as appropriate.

• Assist in the prior authorization (PA) and appeals processes, based on benefit outcomes.

• Serve as an advocate for patients by explaining eligibility, program enrollment, affordability options, and access pathways for prescribed therapies.

• Evaluate program enrollment forms for completeness, accuracy, and data integrity.

• Document case progress and all communications in the case management system in accordance with program policies and privacy regulations.

• Act as a direct point of contact to healthcare providers (HCPs) for ongoing case support, program education, and relationship development.

• Establish rapport and build trust with provider offices and payer representatives to support timely case resolution.

• Maintain accurate and complete communication logs and documentation in compliance with client and industry standards.

• Partner with Field Reimbursement Managers (FRMs) in a regional capacity to align on patient needs, case progression, and provider support.

• Collaborate with FRMs to deliver updates on benefit status, access challenges, and case resolution strategies.

• Act as a resource to internal and external stakeholders to address complex reimbursement issues.

• Ensure full adherence to program SOPs, escalation pathways, call guides, and client expectations.

• Maintain strict HIPAA compliance and ensure all patient data is handled with confidentiality.

• Participate in required training and certification programs on time and in accordance with corporate policies.

• Identify and report Adverse Events (AEs) and pharmacovigilance (PV) information as required by the client.

• Perform special projects and additional tasks as assigned by program leadership.

• Provide exceptional customer service and act as a positive representative of the program and brand.

• Maintain a high level of professionalism, ethical conduct, and reliability in all interactions.

• Work closely with the Program Manager and leadership to communicate trends, provider feedback, and patient status updates.

• Demonstrate a positive attitude and help maintain overall team morale.

• Proactively manage assigned workload, tasks, and case progress using system tools and timelines.

• Work in close alignment with offshore Intake Coordinators (ICs) and offshore Reimbursement Case Managers to ensure accurate intake and task execution.

• Ensure seamless coordination across onshore and offshore teams to deliver consistent, high-quality service execution and effective case management.

• Support visibility, issue resolution, and workflow optimization across all roles contributing to the case lifecycle.

• Associate or Bachelor’s degree preferred; OR a minimum of 4 years of experience in HUB services, reimbursement, healthcare call center, or customer service environment with increasing responsibility.

• Prior experience working in HUB services, patient support programs, or pharmaceutical reimbursement highly preferred.

• Strong understanding of medical insurance terminology, healthcare reimbursement processes, and insurance plan structures (e.g., Commercial, Medicare, Medicaid).

• Experience in healthcare billing, physician office operations, or payer processing is a plus.

• Excellent written and verbal communication skills with the ability to explain complex coverage scenarios to patients and providers.

• Proven ability to problem-solve and make sound decisions in a fast-paced environment.

• Strong attention to detail and follow-through, especially when coordinating between multiple stakeholders.

• Exceptional organizational skills with the ability to manage multiple cases and shifting priorities effectively.

• Demonstrated ability to work independently while contributing to team goals.

• Empathetic listener with a patient-first mindset and a commitment to service excellence.

• Punctual, dependable, and committed to maintaining a strong attendance record.

• Proficient in Microsoft Office Suite (Word, Excel, Outlook, Teams) and capable of quickly learning program-specific systems such as CLS or Salesforce-based platforms.

• Comfortable adapting to change and working within a dynamic, evolving program environment.