Case Manager

Description:

Provides expertise on insurance coverage and common access and reimbursement challenges affecting patients, healthcare providers and clients. The responsibilities include education on access and reimbursement support tools available and the participating program, advising healthcare providers (HCPs) and/or patients and caregivers on the benefits and program eligibility for a specific patient, and educating HCP offices on payor processes and procedures.

A typical day in the life of a Case Manager will include the following:

RELATIONSHIP MANAGEMENT:

– Builds trusted relationships with patients, prescribers, client stakeholders through proactive communication, timely and accurate execution of deliverables and demonstrated relentless passion for helping patients

– Manages all relationships in a manner that adheres to healthcare laws and regulations

COMMUNICATIONS:

– Perform program welcome calls to patients

– Performs post benefits investigations calls to patients and physicians explaining coverage options

– Manages all client inquiries unable to be determined by client through reporting

– Manages HCP inquiries, as applicable, pursuant to business rules

INBOUND CALL MANAGEMENT:

– Manages inbound calls as directed by the program-approved FAQs

– Triage patients to internal or external resources as appropriate

PERSONALIZED CASE MANAGEMENT

– Provides personalized case management to patients and HCPs including outbound communication to HCPs and patients to communicate benefits coverage and next steps in obtaining coverage

– Leverages electronic tool to identify benefits and payer coverage; completes manual benefit investigations as needed

– Identifies and communicates patients plan benefit coverage including the need for prior auth, appeal, tier exception, and/or formulary exclusions

– Uses electronic resources to obtain benefit coverage outcome and if needed ,outbound call to payers and healthcare providers to follow up on proper submission/or outcome

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About TEKsystems:

Were partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. Thats the power of true partnership. TEKsystems is an Allegis Group company.

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.