Case Manager, Reimbursement
virtual vocationsDenver, CO
Case Manager, Reimbursement
Occupations
Claims Adjusters, Examiners, and InvestigatorsCompensation and Benefits ManagersRegulatory Affairs ManagersIndustries
Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension FundsAll Other Miscellaneous Ambulatory Health Care ServicesClaims AdjustingAbout the role
To ensure timely case management oversight, the full-time Case Manager, Reimbursement will coordinate assigned caseloads, manage prior authorizations and appeals, and serve as the primary resource for patients and healthcare providers in a remote work environment.
Key responsibilities:
Provide oversight and coordination of caseload to ensure timely completion of all case elements and tasks
Act as the single point of contact for prior authorization and appeal processing communications with patients and external stakeholders
Assess and refer patients for special programs and perform quality checks on cases, reporting trends to leadership
Required qualifications:
Bachelor's degree or six years of relevant working experience
Two or more years of relevant experience in pharmacy benefit management preferred
Experience as a Medical Assistant, Social Worker, or Senior Reimbursement Specialist preferred
Proficiency in Microsoft Office applications
Knowledge of medical and claims processing terminology
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JOB OVERVIEW
Experience level
Senior
Location
Denver, CO
Occupation
Claims Adjusters, Examiners, and Investigators
Industry
Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds
Posted
yesterday
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