Job Description
Do you speak both English and Spanish fluently and possess a passion for helping patients navigate the complexities of accessing their medications? Are you a highly organized and detail-oriented individual who thrives in a fast-paced, supportive environment? If so, we have an exciting opportunity for you to join our team as a Bilingual Executive Case Manager!
About the Role:
As a Bilingual Executive Case Manager, you'll play a crucial role in ensuring patients have access to the medications they need. You'll be their dedicated support team, guiding them through the often-complicated process of obtaining their prescriptions. You'll provide compassionate and efficient service, understanding that every interaction represents a real person seeking help. You'll use your expertise to communicate clearly, accurately manage medical records, master program requirements, and ensure timely processing of prescriptions and cases. You'll translate complex medical and insurance information into patient-friendly language.
What You'll Do:
Manage the entire patient journey from initiation to closure, using critical thinking and knowledge of program and industry standards.
Conduct benefit investigations, track prior authorizations and appeals, and resolve issues through various communication channels (email, inbound/outbound calls, and our proprietary technology).
Provide expertise on insurance coverage and common access/reimbursement challenges.
Educate patients, healthcare providers, and clients on available support tools and program eligibility.
Advise healthcare providers and patients/caregivers on benefits and program eligibility.
Educate healthcare provider offices on payer processes and procedures.
Build trusted relationships with patients, prescribers, and clients.
Manage all relationships in compliance with relevant laws, regulations, and industry standards (including HIPAA and insurance guidelines).
Manage inbound calls, triaging patients to appropriate resources.
Provide personalized case management, including outbound communication to healthcare providers, pharmacies, and patients.
Leverage electronic tools to identify benefits and payer coverage; complete manual benefit investigations as needed.
Identify and communicate patient's plan benefit coverage, including the need for prior authorization, appeals, tier exceptions, and formulary exclusions.
Serve as a subject matter expert to the internal team.
Use electronic resources to obtain benefit coverage outcomes and follow up with payers and healthcare providers.
Coordinate nurse teaching with nurse educators, as applicable.
Support adherence services, as applicable.
Identify peer support resources for patients.
Proactively communicate needs for reverification of prior authorization or re-enrollment.
Identify and report adverse events, product complaints, and medical inquiries.
Document all activities within our system, maintaining detailed records of reimbursement activities.
Generate reports and analyses as needed.
What You'll Bring:
Bachelor's degree (or higher) required (healthcare administration, social science, or related field preferred). Experience may be substituted for degree.
Two years of experience in insurance reimbursement, patient access, direct patient care, or patient education required.
Minimum two years of experience in healthcare access delivery or management strongly preferred.
Fluency in English and Spanish required.
Other relevant certifications (e.g., PACS, CHES, CCM) considered with five or more years of experience.
Strong understanding of medical terminology, coding systems (ICD-10, CPT, HCPCS), and insurance processes.
Demonstrated ability to execute within established guidelines, recognize urgency, and deliver patient-centric results.
Excellent attention to detail and organizational skills.
Ability to prioritize tasks and work efficiently in a fast-paced environment.
Effective written and verbal communication and interpersonal skills.
Critical thinking and problem-solving skills.
Knowledge of healthcare compliance regulations (HIPAA and Medicare/Medicaid).
What We Offer:
Competitive Compensation: Competitive starting pay rates.
Comprehensive Benefits: Company-paid short-term disability, increased 401(k) match, affordable medical/dental/vision plans (with 75% of medical premiums covered), free concierge medical clinic, wellness discounts, annual HSA employer contribution, company-paid and voluntary life insurance, paid parental leave, wellness and employee assistance programs, generous PTO, flex days, paid holidays, employee referral program, ambassador program, and tuition reimbursement.
Career Growth: Opportunities for advancement.
Supportive Culture: A challenging, stimulating work environment that encourages new ideas and values diversity and inclusion.
Modern Workplace: Our state-of-the-art headquarters offers many amenities.
Additional Information:
All employees working onsite are strongly encouraged to be vaccinated against COVID-19.
Toll reimbursement is available after 40 trips per month.
Due to training investments, a minimum of 6 months in the role is expected before considering lateral or promotional moves.
This is an office-based position requiring the ability to sit for extended periods. Standard 8.5-hour shifts between 8 AM and 11 PM, Monday through Friday, will be assigned.
Remote work eligibility is subject to meeting work-from-home criteria and business needs.
Ready to Empower Patients?
If you're a bilingual, highly organized, and compassionate individual looking for a rewarding career where you can make a real difference, we encourage you to apply! We are an equal opportunity employer and value diversity. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, 1 age, marital status, veteran status, or disability status.
Employment Type: Full-Time
Salary: $ 78,114.00 Per Year
Job Tags
Holiday work, Full time, Temporary work, Remote job, Flexible hours, Shift work, Monday to Friday,