Sr. Case Manager, Reimbursement
United Biosource Corporation
Summary
The primary purpose of this position is to provide day-to-day case management oversight and coordination of assigned caseload to ensure parties responsible for tasks are completing them timely, as well as act as a primary resource for patients, healthcare providers and field reimbursement.
Job description
Specific job duties
- Provide day-to-day oversight and coordination of caseload to ensure all case elements and tasks are completed timely and ensure cases move through the process as required.
- Act as single point of contact responsible for prior authorization and appeal processing communications to patients, healthcare providers, field reimbursement representatives and other external stakeholders.
- Serve as a patient advocate and resource for patients as they navigate through the reimbursement process while coordinating any additional patient access services within program guidelines.
- Performs quality checks on cases and report trends to leadership.
- Troubleshoot complex cases, spanning multiple disease-states, while interfacing with key stakeholders (internal/external) to ensure optimal start to therapy.
- Report Adverse Drug Events that have been experienced by the patient in accordance pharmaceutical requirements.
- Recognize a product quality complaint and forward caller/written information to a manufacturer.
- Act as point of contact for case managers to assist with prior authorization and appeal requirements, provide guidance, answer process questions and address escalated issues when appropriate.
- Provides support for at-risk patients and prescribers to help mitigate any lapse in the start or continuation of therapy.
- Collaborates with other senior case managers, managers and quality team on a monthly basis to review quality trends, creating process improvement initiatives for the next month.
- Prepares and presents team huddles, and client presentations as deemed appropriate (minimum one presentation per month).
Requirements
- Bachelor's degree or six years of relevant working experience
- Three (3) or more years of relevant experience in pharmacy and/or medical benefit verifications, prior authorization and/or appeals required
- Five (5) or more years of relevant experience in pharmacy benefit management, specialty pharmacy or patient support/access (HUB) services preferred
- Medical Assistant, Social Worker or Senior Reimbursement Specialist experience preferred
- Proficient in Microsoft Office applications
- Knowledge of medical and claims processing terminology
- Excellent written/verbal communication to include providing clear instructions
- Strong critical thinking skillset along with the ability to multi-task
Benefits
- Remote opportunities
- Competitive salaries
- Growth opportunities
- 401(k) Matching
- Tuition reimbursement
- Flexible work environment
- 20 Days PTO
- Paid Holidays
- Employee assistance programs
- Medical, Dental & Vision
- HSA/FSA
- Telemedicine
- Wellness program
- Adoption assistance
- Short term disability
- Long term disability
- Life insurance
- Discount programs
Company overview
United BioSource Corporation (UBC) is a leading provider of pharmaceutical support services and evidence development solutions, founded in 2003 and headquartered in King of Prussia, Pennsylvania. The company specializes in uniting evidence and access to improve patient outcomes for biopharmaceutical companies. UBC partners with life science organizations to demonstrate the safety, efficacy, and value of pharmaceutical and medical products through comprehensive solutions in access, safety, and evidence generation. Their services include modernized study design, late-stage research, risk evaluation and mitigation strategies (REMS), pharmacovigilance, patient access programs, and real-world evidence development. With a focus on specialty therapies, UBC helps biopharma companies navigate regulatory requirements, optimize commercialization strategies, and ensure therapies reach patients who need them most. The company operates globally with multiple locations across the United States, Europe, and other regions, serving as a critical partner in the pharmaceutical development lifecycle.