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Role Description

Care Managers are responsible for contacting insurance companies to obtain correct eligibility information, perform benefit investigations, copay assistance and check prior authorization and/or appeal status. Responsibilities will vary by program and its lifecycle.

• Perform outbound calls to obtain appropriate information and document accurately.
• Responsible for answering inbound calls and assisting customers with pharmacy related services.
• Maintain strict professionalism in all communication methods while providing efficient, courteous, and friendly service.
• Contact insurance companies for benefit investigation and coverage eligibility.
• Provide prior authorizations and appeals support.
• Assist patients with the enrollment process for manufacturer and non-profit organization copay assistance programs.
• Update job knowledge by participating in educational opportunities and training activities.
• Work efficiently both individually and within a team to accomplish required tasks.
• Maintain and improve quality results by adhering to standards and guidelines by meeting quality standards set forth by program KPI’s.
• Report ADE’s according to program policy and guidelines.
• Adhere to all HIPAA guidelines.
• May assist with onboarding new employees.

This is a remote position. Must be available for an 8 hour shift between 8am-8pm EST.

Qualifications

• High School Diploma or equivalent.
• Bilingual Spanish - English.
• Minimum one year experience in medical billing, reimbursement, insurance verification, or similar related medical office experience.
• Previous data entry experience (minimum three months) and ability to type 30wpm+.
• Able to demonstrate high attention to detail in work.
• Must be computer savvy, including navigating multiple computer tabs, monitors, and applications.
• Advanced ability/knowledge of all Microsoft Suite programs (Teams, Word, Excel, Outlook, etc.) and soft phone systems (WebEx, Mitel, Shoretel, etc.).
• Exceptional communication skills, both written and verbal.
• Able to work in a virtual team environment by being available and responsive during working hours.
• Excellent follow through.
• Employees must have a private workspace free of distraction to adhere to HIPAA compliance/guidelines.
• Workspace must include internet plug-in accessibility. Wi-fi connectivity is not permitted.
• Must reside in country where the job is posted.

Preferred Qualifications

• Some College.
• Previous experience in Patient Support Services (Hub).
• Previous Customer Service experience in the healthcare field.

Compensation

The potential base pay range for this role is $22.00 - $24.00 per hour. The actual base pay offered may vary based on a number of factors including job-related qualifications such as knowledge, skills, education, and experience; location; and/or schedule (full or part-time).