Care Manager
Wilson, Wilson County, North Carolina, 27893, USA
Listed on 2026-10-02
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Healthcare
Healthcare Administration, Medical Billing and Coding, Medical Office
Description
Position Summary:
Care Manager responsibilities will vary by program and its lifecycle. Care Manager's may be responsible for contacting insurance companies to obtain correct eligibility information, perform benefit investigations, copay assistance and check prior authorization and/or appeal status. Care managers may also be responsible for directly contacting patients and/or providers to evaluate eligibility for assistance programs and/or varied adherence support. This is a remote position.
The information contained herein is intended to be an accurate reflection of the duties and responsibilities of the individuals assigned to this position. They are not intended to be an exhaustive list of the skills and abilities required to do the job. All Care Plus Pharmacy reserves the right to revise the job or to require that other or different tasks be performed as assigned.
Primary Responsibilities:- Responsible for all inbound and outbound phone calls to patients and providers.
Responsible for single point of contact communication with providers and patients in a designated geographical area
Contact insurance companies to perform appropriate benefit investigation(s) and coverage eligibility for client product only
If applicable, assist with the prior authorizations with specific attention to detail and accuracy with provided information.
Assist patients with the enrollment process for manufacturer and non-profit organization copay assistance programs
Provide courteous, friendly, professional and efficient service to internal and external customers including physicians and patients.
Update job knowledge by participating in educational opportunities and training activities
Work efficiently both individually and within a team to accomplish required tasks
Maintain and improve quality results by adhering to standards and guidelines and recommending improved procedures
Eligibility authorization and enrollment into Patient Assistance Program(s)
Ability to verify insurance requirements to support current billing processes
Demonstrate a firm grasp of medical billing processes communicating knowledge to internal and external customers
Identifying and providing corrective action for medical billing reimbursement support specifically to provider offices
High School Diploma or equivalent, some college preferred
Minimum two years experience in pharmacy, medical billing, insurance verification, and/or similar related healthcare experience; must include work with J-code and/or HCPCS
Customer Service experience
Healthcare experience
Previous experience in Patient Support Services (Hub)
Previous Customer Service experience in the healthcare field
Competencies:
General Management
Demonstrate analytic and problem solving skills, and understand the impact of individual decisions on other parts of the organization and the environment.
Quality improvement
Application of techniques that continually improve the quality of care provided, patient safety, organizational performance, and the financial health of the organization.
Knowledge of the Health Care Environment
Health Care Systems and Organizations
Demonstrate an understanding of how the various components of the health care system is organized and financed, and how they interact to deliver medical and health care.
The Patient's Perspective
Understand the patient experience, demonstrate a commitment to patients' rights and responsibilities, and ensure that the organization provides a safe environment for patients and their families.
Communication and Relationship Management
Relationship Management
The ability to build and maintain relationships with internal as well as external stakeholders that are anchored in trust and…
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