PharmaCord
Important Notice
Important Notice
Due to an increase in hiring scams, please be aware that if you are selected to move forward in our hiring process, a member of our Talent Acquisition team will contact you directly using an official
@pharmacord.com
and/or
@echo.newtonsoftware.com
email address regarding next steps in our interview process.
PharmaCord will never use Microsoft Teams to reach out to candidates for interview scheduling. However, video interviews are typically conducted via Microsoft Teams. Official meeting links will always be sent from an @pharmacord.com or @echo.newtonsoftware.com email address, or through our scheduling platform, Calendly.
We will never request your bank account information at any stage of the hiring process.
We will never send a check (electronic or physical) to purchase home office equipment.
If you receive any suspicious communication regarding employment with PharmaCord, please report it to our Talent Acquisition team immediately at
careers@pharmacord.com .
This is a remote role. Candidates must reside in the state of Indiana.
Executive Case Manager – Role Overview When you join the team as an Executive Case Manager, you will have the opportunity to make a difference in the lives of our patients by supporting them through the process of obtaining access to their complex medication. You will compassionately deliver an exceptional experience to patients by ensuring accurate, timely management of their records and clear communication. You will translate program requirements into patient-friendly language and education, and adapt your approach to the needs of each patient.
A typical day includes ownership of the patient journey from initiation to closure, using critical thinking and knowledge of the program and industry rules and standards. This includes completing benefit investigations, tracking prior authorizations/denial appeals, and assisting patients or other callers/stakeholders through resolution (via email, inbound/outbound calls and using our Lynk platform). This role requires a strong understanding of pharmacy and medical billing and coding, excellent communication skills, and the ability to navigate complex reimbursement processes.
The Executive Case Manager provides expertise on insurance coverage and common access and reimbursement challenges affecting patients, healthcare providers and clients. Responsibilities include education on the access and reimbursement tools available from PharmaCord and participating programs, advising healthcare providers and/or patients and caregivers on benefits and program eligibility, and educating offices on payor processes and procedures.
Key Responsibilities The following responsibilities are representative and include but are not limited to:
Relationship Management
Build trusted relationships with patients, prescribers, and client stakeholders regarding reimbursement inquiries and challenges through proactive communication and accurate execution of deliverables.
Compliance & Communication
Manage all relationships in accordance with applicable laws, regulations, program procedures, and industry standards (HIPAA, insurance guidelines).
Support inbound and outbound calls to patients, caregivers, specialty pharmacies and healthcare professionals.
Perform post-benefit investigation calls to patients and/or physicians explaining coverage options and next steps.
Manage client inquiries and HCP inquiries as appropriate per business rules.
Inbound/Outbound Management
Handle inbound calls per program-approved FAQs and triage patients to appropriate resources.
Personalized Case Management
Provide outbound communication to HCPs, pharmacies and patients to communicate benefit coverage and drive next steps for coverage/access.
Identify and communicate patient plan benefit coverage needs (prior authorization, appeals, formulary considerations).
Use electronic resources to obtain benefit coverage outcomes and follow up with payers/HCPs as needed.
Coordinate nurse teaching with nurse educators and support adherence services as applicable.
Identify peer support resources and proactively communicate needs for reverification of prior authorization or re-enrollment.
Document all activities in the PharmaCord Lynk system with detailed records of reimbursement activities.
Generate reports and analysis to identify trends and opportunities for improvement.
Requirements
Completion of Bachelor's degree (or higher) required
A degree in healthcare administration, social science or related fields strongly preferred
Minimum two years of experience in healthcare access delivery or management strongly preferred
5–10 years of experience in insurance reimbursement, patient access, direct patient care or patient education will be considered in lieu of a degree
Other certifications and five or more consecutive years of experience in relevant field may be considered (examples: PACS, CHES, CCM)
Strong understanding of medical terminology, coding systems (ICD-10, CPT, HCPCS) and insurance processes
Excellent attention to detail and organizational skills; ability to prioritize in a fast-paced environment
Effective written and verbal communication with diverse stakeholders
Critical thinking and issue resolution skills
Knowledge of healthcare compliance regulations (HIPAA, Medicare/Medicaid)
Bi-lingual skills are a plus
Location: Jeffersonville, IN with possible on-site travel; remote work eligibility subject to criteria and business need
Physical Demands & Work Environment
Office-based position with the ability to sit for extended periods
Must be able to type 35 WPM with 97% accuracy and perform standard office tasks
Minimal travel may be necessary
Standard office environment with equipment such as computers and phones
Standard shift expectations within business hours (8:00 am – 9:00 pm, Monday–Friday); shift may change based on business needs
Role requires commitment to a minimum tenure of 6 months for program-specific training; exceptions reviewed case-by-case
Benefits & Perks
Company paid Short-term Disability (STD)
Competitive 401(k) company match up to 4%
Medical, Dental, and Vision benefits
Annual HSA employer contribution
Company paid and voluntary Life Insurance options
Voluntary Life, AD&D and Long-Term Disability Insurance
Wellness and Employee Assistance Programs
PTO, flex days and paid holidays
Employee Referral Program
Ambassador Program
Additional Information
Offers contingent on completion of a background check
This job description is not a comprehensive listing of duties; duties may change
PharmaCord is an equal opportunity employer
PharmaCord does not sponsor Visa workers at this time
Learn more about us on LinkedIn, Glassdoor, Twitter, and Facebook
#J-18808-Ljbffr
Due to an increase in hiring scams, please be aware that if you are selected to move forward in our hiring process, a member of our Talent Acquisition team will contact you directly using an official
@pharmacord.com
and/or
@echo.newtonsoftware.com
email address regarding next steps in our interview process.
PharmaCord will never use Microsoft Teams to reach out to candidates for interview scheduling. However, video interviews are typically conducted via Microsoft Teams. Official meeting links will always be sent from an @pharmacord.com or @echo.newtonsoftware.com email address, or through our scheduling platform, Calendly.
We will never request your bank account information at any stage of the hiring process.
We will never send a check (electronic or physical) to purchase home office equipment.
If you receive any suspicious communication regarding employment with PharmaCord, please report it to our Talent Acquisition team immediately at
careers@pharmacord.com .
This is a remote role. Candidates must reside in the state of Indiana.
Executive Case Manager – Role Overview When you join the team as an Executive Case Manager, you will have the opportunity to make a difference in the lives of our patients by supporting them through the process of obtaining access to their complex medication. You will compassionately deliver an exceptional experience to patients by ensuring accurate, timely management of their records and clear communication. You will translate program requirements into patient-friendly language and education, and adapt your approach to the needs of each patient.
A typical day includes ownership of the patient journey from initiation to closure, using critical thinking and knowledge of the program and industry rules and standards. This includes completing benefit investigations, tracking prior authorizations/denial appeals, and assisting patients or other callers/stakeholders through resolution (via email, inbound/outbound calls and using our Lynk platform). This role requires a strong understanding of pharmacy and medical billing and coding, excellent communication skills, and the ability to navigate complex reimbursement processes.
The Executive Case Manager provides expertise on insurance coverage and common access and reimbursement challenges affecting patients, healthcare providers and clients. Responsibilities include education on the access and reimbursement tools available from PharmaCord and participating programs, advising healthcare providers and/or patients and caregivers on benefits and program eligibility, and educating offices on payor processes and procedures.
Key Responsibilities The following responsibilities are representative and include but are not limited to:
Relationship Management
Build trusted relationships with patients, prescribers, and client stakeholders regarding reimbursement inquiries and challenges through proactive communication and accurate execution of deliverables.
Compliance & Communication
Manage all relationships in accordance with applicable laws, regulations, program procedures, and industry standards (HIPAA, insurance guidelines).
Support inbound and outbound calls to patients, caregivers, specialty pharmacies and healthcare professionals.
Perform post-benefit investigation calls to patients and/or physicians explaining coverage options and next steps.
Manage client inquiries and HCP inquiries as appropriate per business rules.
Inbound/Outbound Management
Handle inbound calls per program-approved FAQs and triage patients to appropriate resources.
Personalized Case Management
Provide outbound communication to HCPs, pharmacies and patients to communicate benefit coverage and drive next steps for coverage/access.
Identify and communicate patient plan benefit coverage needs (prior authorization, appeals, formulary considerations).
Use electronic resources to obtain benefit coverage outcomes and follow up with payers/HCPs as needed.
Coordinate nurse teaching with nurse educators and support adherence services as applicable.
Identify peer support resources and proactively communicate needs for reverification of prior authorization or re-enrollment.
Document all activities in the PharmaCord Lynk system with detailed records of reimbursement activities.
Generate reports and analysis to identify trends and opportunities for improvement.
Requirements
Completion of Bachelor's degree (or higher) required
A degree in healthcare administration, social science or related fields strongly preferred
Minimum two years of experience in healthcare access delivery or management strongly preferred
5–10 years of experience in insurance reimbursement, patient access, direct patient care or patient education will be considered in lieu of a degree
Other certifications and five or more consecutive years of experience in relevant field may be considered (examples: PACS, CHES, CCM)
Strong understanding of medical terminology, coding systems (ICD-10, CPT, HCPCS) and insurance processes
Excellent attention to detail and organizational skills; ability to prioritize in a fast-paced environment
Effective written and verbal communication with diverse stakeholders
Critical thinking and issue resolution skills
Knowledge of healthcare compliance regulations (HIPAA, Medicare/Medicaid)
Bi-lingual skills are a plus
Location: Jeffersonville, IN with possible on-site travel; remote work eligibility subject to criteria and business need
Physical Demands & Work Environment
Office-based position with the ability to sit for extended periods
Must be able to type 35 WPM with 97% accuracy and perform standard office tasks
Minimal travel may be necessary
Standard office environment with equipment such as computers and phones
Standard shift expectations within business hours (8:00 am – 9:00 pm, Monday–Friday); shift may change based on business needs
Role requires commitment to a minimum tenure of 6 months for program-specific training; exceptions reviewed case-by-case
Benefits & Perks
Company paid Short-term Disability (STD)
Competitive 401(k) company match up to 4%
Medical, Dental, and Vision benefits
Annual HSA employer contribution
Company paid and voluntary Life Insurance options
Voluntary Life, AD&D and Long-Term Disability Insurance
Wellness and Employee Assistance Programs
PTO, flex days and paid holidays
Employee Referral Program
Ambassador Program
Additional Information
Offers contingent on completion of a background check
This job description is not a comprehensive listing of duties; duties may change
PharmaCord is an equal opportunity employer
PharmaCord does not sponsor Visa workers at this time
Learn more about us on LinkedIn, Glassdoor, Twitter, and Facebook
#J-18808-Ljbffr