Case Manager at Avacend

Job Title: Case Manager Duration:to Location: 11800 Weston Parkway Cary NC USA 27513 Screening Questions: Q1: Do you have experience or background in specialty pharmacy and HUB operations. Q2: Do you have reliable transportation to be onsite 5 days a week A2: If no this role is not a good fit. Q3. What case management or customer service experience do you have Description: MON-FRI . Shift hours (8 am -8 pm) 8-5 shift 10-7 shift 11-8 shift Onsite Mandatory skills: Pharmacy or Health Care Experience minimum 2 years Perks of the assignment: Cross training opportunity team events/activities. Possible conversion to FTE at end of contract Prioritize customer questions and answer within inbound calls within SLAs. Ideal candidate will need to work independently with minimum supervision. Detail oriented. Must be able to work on site for the duration of program launch. Should be comfortable working independently with minimal guidance from management) Will be processing high volume of cases to include benefit verifications and insurance reverifications. Work Schedule: (Ex: M-F 8am-8pm) Onsite. Purpose The Case Manager is responsible for working closely with healthcare providers patients and drug manufacturer programs managing complex reimbursement issues. Must have an in-depth understanding of insurance plans and benefit structures in order to obtain detailed benefit information and maximize plan benefits. Obtains payer specific prior authorization procedures and documentation requirements if applicable and facilitates the prior authorization process for patients and healthcare providers. Needs to have an in-depth understanding of Medicare and Medicaid programs in order to effectively utilize internal resources and to conduct external research to identify alternate funding sources as appropriate. Essential Duties and Responsibilities Work with healthcare providers and patients to assist with appeal management for claim denials. Work with physicians and payers to advocate for product specific coverage. Ability to communicate product benefits and efficacy to positively influence payer policy. Capability to monitor drug coverage policies for multiple payers. Review case outcomes to analyze and identify payment and denial trends as well as key findings for client reporting. Ability to effectively respond to escalated issues and complex cases referred from other Reimbursement employees or manufacturer representatives. Conduct external research to identify appropriate alternate funding sources for inclusion to the internal resource database for future reference purposes. Qualifications/Requirements High School Diploma or Equivalent 5 years experience in the healthcare industry including but not limited to Medicare and/or Medicaid program administration insurance verification and/or claim adjudication physicians office or outpatient billing pharmacy and/or pharmaceutical manufacturers. Must be able to analyze reimbursement specific data and prepare written reports for management and client communications. 2 years customer service experience and 2 years medical or insurance industry experience. Excellent communication and organizational skills. Strong problem solving and decision-making skills and ability to effectively handle multiple priorities. Key Skills Project Portfolio Management,Motivational Interviewing,HIPAA,Computer Skills,Intake Experience,Lean Six Sigma,Conflict Management,Case Management,Team Management,Program Development,Social Work,Addiction Counseling Employment Type : Full Time Experience: years Vacancy: 1