1+ months

Case Manager/ Sr. Reimbursement Specialist

Kelly Services
Lake Mary, FL 32795
**Kelly Services is looking for a Case Manager/ Sr Reimbursement Specialist for the Healthcare Benefits Industry.**

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.

The Case Manager is responsible for ensuring prior authorizations, reauthorizations and appeals are obtained timely, as well as ensuring accurate documentation of payer information and patient status.

In addition, the Case Manager is responsible for completing a pre-screen to determine eligibility for additional services such as injection services, co-pay mitigation, and patient assistance programs PAP , if applicable.

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.

Communicate patient benefits and responsibility timely and accurately. Assess and refer patients appropriately for special programs/services when appropriate. Performs quality checks on cases and report trends to leadership.

Responsible for good housekeeping techniques, adhering to quality and production standards while complying with all applicable company, state and federal safety and environmental programs and procedures.

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.

**Desired Skills and Qualifications:**

Bachelor s degree or six years of relevant working experience

Two 2 or more years of relevant experience in pharmacy benefit management preferred 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.

Must possess a strong critical thinking skillset along with the ability to multi-task I acknowledge that the job for which I have applied is represented by the description above.

**Why Kelly** **** **?**

As a worker today, its up to you to take charge of your career and look for opportunities to learn, grow, and achieve your potential. Helping you find whats next is what were all about. We know whats going on in the evolving world of workjust ask the 440,000 people we employ each year. Connecting with us means getting the support, guidance, and opportunities needed to take your career where you may have never imagined.

**About Kelly** ****

At Kelly, were always thinking about whats next and advising job seekers on new ways of working to reach their full potential. In fact, were a leading advocate for temporary/non-traditional workstyles, because we believe they allow flexibility and tremendous growth opportunities that enable a better way to work and live. Connecting great people with great companies is what we do best, and our employment opportunities span a wide variety of workstyles, skill levels, and industries around the world.

Kelly is an equal opportunity employer committed to employing a diverse workforce and providing accommodations for people with disabilities in all parts of the hiring process as required under its Employment Accommodation Policy. Kelly will work with applicants to meet accommodation needs that are made known to Kelly in advance.
Posted: 2020-10-16 Expires: 2020-12-14

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Case Manager/ Sr. Reimbursement Specialist

Kelly Services
Lake Mary, FL 32795

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