Care Coordinator

Overview

This opportunity is available through a partner company based in the United States seeking a Care Coordinator to facilitate patients' access to healthcare therapies by overcoming barriers related to medication availability and insurance reimbursements. The role serves as a critical liaison among healthcare providers, patients, payers, pharmacies, and internal teams, emphasizing patient advocacy, healthcare knowledge, relationship management, and operational coordination.

Key Responsibilities

• Communicate with healthcare providers and office staff via multiple channels to clarify product coverage and reimbursement rules.
• Manage the entire reimbursement workflow including patient enrollments, insurance verifications, prior authorizations, appeals, denial handling, and financial aid facilitation.
• Educate healthcare personnel on patient assistance and pathways for treatment access.
• Act as a resource for payers and pharmacies within assigned accounts, informing stakeholders of updates and changes.
• Track payer policies, insurance coverage trends, and market access challenges to identify obstacles and opportunities affecting patient care.
• Collaborate with internal and external parties to implement patient access strategies and enhance therapy adoption.
• Maintain expertise in specialty pharmacy processes, hub services, insurance benefits, and reimbursement frameworks.
• Analyze regional data and performance reports to detect trends and assist strategic decisions.
• Meet service-level agreements, key performance indicators, and operational targets consistently.
• Adapt to shifting priorities and complex account needs while upholding exceptional service standards.
• Gather customer feedback through effective communication, investigative research, and problem solving to aid program advancement.
• Accurately document activities within CRM and reporting systems adhering to ethical and compliance standards.

Candidate Requirements

• A Bachelor’s degree is preferred; advanced degrees are advantageous.
• At least 3 years of relevant experience in healthcare reimbursement, managed care, pharmaceutical services, clinical support, or similar roles.
• Experience with specialty pharmacy, patient support programs, hub operations, or healthcare provider engagement is desirable.
• Comprehensive knowledge of health insurance benefits including Medicare Part D, commercial insurance, Medicaid, and patient assistance programs.
• Understanding of challenges related to specialty product reimbursement and strategies to mitigate barriers.
• Familiarity with CMS policies and Medicare Part D procedures is a plus.
• Awareness of managed care organizations, government payer frameworks, and integrated healthcare systems is beneficial.
• Proficiency with Microsoft Office, particularly Excel, and reporting tools such as Tableau.
• Experience utilizing complex CRM systems like Salesforce, Veeva, or equivalents to manage patient access data.
• Strong analytical, research, critical-thinking, and problem-solving skills.
• Excellent written and oral communication skills coupled with meticulous attention to detail.
• Ability to manage multiple tasks autonomously in a remote work setting.
• Prior customer service experience in healthcare or call center environments is preferred.
• Effective collaboration capabilities to work cross-functionally within teams.
• Willingness and eligibility to travel occasionally (under 10%) as needed.

Benefits and Working Conditions

• Competitive hourly wage ranging from $24 to $29.
• Fully remote work with territory-based responsibilities.
• Full-time schedule, Monday through Friday.
• Comprehensive medical, dental, and vision insurance coverage.
• Engagement in meaningful healthcare initiatives aimed at enhancing patient outcomes.
• Collaborative environment working alongside healthcare professionals and diverse teams.
• Access to professional development opportunities.
• Paid time off along with additional employee benefits.

Additional Information

This position is managed by a partner organization responsible for application processing and subsequent recruitment stages. The role emphasizes adherence to all ethical, legal, and compliance regulations. Applicants should be prepared to manage data privacy in line with relevant data protection laws.