Case Manager Associate (CALL CENTER)

Description:

Job Responsibilities for Benefit Specialist:

- Performing patient level benefits verifications for all major medicals and pharmacy benefit plans

- Completion of template forms that provide patent level benefits Coverage Determination Summary

- Coordination of prior authorizations based on payer guidelines and in compliance with law, regulation or guidance

- Review of patient assistance enrollment forms and any supporting documentation to assess patient eligibility for participation as per SOP's and program guidelines

- Determination of patient's eligibility based upon program criteria for qualification

- Communicating the patient's eligibility to the patient, healthcare provider and/or consignment pharmacy.

- Answer and assist inbound callers through resolution utilizing answers to frequently asked questions or by warm transferring callers to other appropriate individuals

- Actively listen to each customer, assess needs and respond with demonstrated patience and courtesy

- Review and identify information that is missing and/or incorrect within program service requests

Benefits Overview: 

• 12 PTO days, 8 paid holidays and 1 flex day 
• Retention bonus up to $500 paid out in two milestones over 6 months ($250 at 90 days and another $250 at 6 months) 
• Hybrid working opportunities after 6 months of hire (must be on hybrid eligible program) 
• One week in office, one week WFH  
• Shift options between 8am – 11pm Monday – Friday with premium pay for late hours 
• 401(k) with 4% company match 
• Affordable Medical, Dental, and Vision benefits - PharmaCord covers 75% of Medical Premiums if enrolled in HSA plan for our employees 
• NEW! Wellness discount up to $260 per year 
• NEW! Concierge medical clinical free of cost to you and your family members even if they are not enrolled on our health plan (employee must be enrolled) 
• Annual HSA employer contribution ($500 - $1,500 depending on enrollment level) 
• Company paid Life Insurance 
• Company paid Short Term Disability Insurance 
• Voluntary Life and AD&D Insurance 
• Long-term Disability (LTD) 
• Paid Parental Leave of Absence 
• 8 weeks of maternity leave paid at 100% 
• 1 week of paternity leave paid at 100% 
• Employee Assistance Programs 
• Employee Referral Program currently $1,000 until end of January 2023 for hired referrals after retention period 
• Ambassador Program 
• Tuition reimbursement program up to $5,000 annually 
• Toll reimbursement program up to $624 annually 

Job Responsibilities for Case Manager:

- Compassionately deliver an exceptional experience to many patients per day always remembering that every prescription or document belongs to a real person who is looking for thorough efficient management of their records.

- Adjust your approach to their needs by communicating clearly, focusing on the accuracy of the details of their medical records and your mastery of the program requirements, and ensuring their prescriptions or cases are handled timely.

- Reporting of Adverse Events/Product Complaint inquiries received in accordance with SOP and good manufacturer practices

- Provides timely feedback to the company regarding service failures r customer concerns

- Effectively uses internal technology platform to complete claims processing and keep workflows moving

- Communicate with key medical practice accounts, sales representatives regarding the status of cases

- Provide consultative services where issues arise on how obstacles can be overcome to get patient on paid therapy

Skills:

Customer service, Benefits administration, Prior Authorization, Benefit verification, Call center, Health insurance, Pharmacy, Insurance, Health care, Microsoft office

Top Skills Details:

Customer service,Benefits administration,Prior Authorization,Benefit verification,Call center,Health insurance,Pharmacy

Additional Skills & Qualifications:

Requirements:

- Bachelor's degree strongly preferred or equivalent experience required; completion of high school diploma or GED is required

- Healthcare experience required - unless candidate has bachelors degree & Strong customer service experience/tenure

- Medical terminology - strongly preferred

- 6 months of payer benefits experience (reimbursement, prior auth, etc), healthcare industry experience or healthcare related experience is required

- Bilingual is a plus

DISQUALIFIERS:

- CNA experience only

- Warehouse experience

- Job hoppy backgrounds - more than 2 jobs within the last year

Additional Qualifications:

- Service minded individuals - focus on recognizing and meeting the needs of others (especially patients and care partners)

- Trouble-shooting and problem solving individuals

- Tough conversations - able to be a patient advocate for patients with high prescription costs

- Ability to handle personal health information with confidentiality

- Commitment to honesty and integrity

- Professionalism and a strong sense of proper business and customer service etiquette

- Clear verbal and written communication skills

- Accountability for results

- Ability to plan and prioritize tasks with close attention to detail

- Positive Attitude

Top Companies they like to see on a resume: RxCrossroads, Humana, Norton, Chewy,

**All employees working on-site are strongly encouraged to be vaccinated against COVID-19, but not required**

Here is the video to include for all candidates to watch prior to their internal interview with PC. https://pharmacord.com/patient-support-services-jobs

*PLEASE INCLUDE IN YOUR INTERVIEW PREP*

Experience Level:

Entry Level

About Aston Carter:

Please Note: Scammers are posing as Aston Carter. We'll never contact you via Gmail, Telegram, or WhatsApp and we'll never solicit money from you.

At Aston Carter, we’re dedicated to expanding career opportunities for the skilled professionals who power our business. Our success is driven by the talented, motivated people who join our team across a range of positions – from recruiting, sales and delivery to corporate roles. As part of our team, employees have the opportunity for long-term career success, where hard work is rewarded and the potential for growth is limitless.

Established in 1997, Aston Carter is a leading staffing and consulting firm, providing high-caliber talent and premium services to more than 7,000 companies across North America. Spanning four continents and more than 200 offices, we extend our clients’ capabilities by seeking solvers and delivering solutions to address today’s workforce challenges. For organizations looking for innovative solutions shaped by critical-thinking professionals, visit AstonCarter.com. Aston Carter is a company within Allegis Group, a global leader in talent solutions.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please call 888-237-6835 or email astoncarteraccommodation@astoncarter.com for other accommodation options. However, if you have questions about this position, please contact the Recruiter located at the bottom of the job posting. The Recruiter is the sole point of contact for questions about this position.

Salary : $37,440 - $41,600