Job Information
Randstad US case manager in cary, North Carolina
case manager.
cary , north carolina
posted 2 days ago
job details
summary
$20 - $21.50 per hour
temporary
high school
category business and financial operations occupations
referenceAB_4564287
job details
The Customer Service Rep patient access Case Manager works in a fast paced, high-volume contact center environment with a variety of product support programs managing complex reimbursement issues. Works closely with healthcare providers and patients to assist with appeal management for claim denials. Works with physicians and payers to advocate for product specific coverage per payer specific P&T Committee protocol therefore, must possess the ability to communicate product benefits and efficacy and positively influence payer policy. Potential Temp To Hire opportunity. Shift is 8 hours a day (anywhere between 8 am - 8 pm). Hybrid. Minimum Requirements
2+ years customer service experience
2+ years medical or insurance industry experience
HS Diploma or Equivalent
Critical Skills
5 years experience in the healthcare industry including, but not limited to, Medicare and/or Medicaid program administration, insurance verification and/or claim adjudication, physician's office or outpatient billing, pharmacy and/or pharmaceutical manufacturers
Must be able to analyze reimbursement specific data and prepare written reports for management and client communications.
Additional Knowledge & Skills
Excellent communication and organizational skills
Excellent problem solving and decision making skills
Ability to effectively handle multiple priorities within a changing environment
Excellent Interpersonal skills
Solid oral and written communication skills
Computer literacy
ICD-9, HCPCS, CPT experience
salary: $20 - $21.5 per hour
shift: First
work hours: 8 AM - 5 PM
education: High School
Responsibilities
Process and perform adjudication of specialty pharmacy claims through point of sale functions.
Manage assigned queues keeping up-to-date and current on all claims.
Serve as a technical resource pertaining to adjudication while identifying areas for improvement.
Interact with other teams and function in strict accordance with standard, written procedures, and guidelines.
Enter detailed, accurate, and grammatically correct progress notes.
Must have an in-depth understanding of insurance plans and benefit structures in order to obtain detailed benefit information and maximize plan benefits.
Obtains payer specific prior authorization procedures and documentation requirements if applicable and facilitate the prior authorization process for patients and healthcare providers.
Needs to have an in-depth understanding of Medicare and Medicaid programs in order to effectively utilize internal resources and to conduct external research to identify alternate funding sources as appropriate.
Position may require sales, project management and/or account coordination skills depending on the specific program.
Skills
Customer Service
Pharmacy Claims
Healthcare
Contact Center
Medical Claims Adjudication
Qualifications
Years of experience: 2 years
Experience level: Experienced
Randstad is a world leader in matching great people with great companies. Our experienced agents will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temporary-to-permanent or permanent opportunities, no one works harder for you than Randstad.
Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.
At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact HRsupport@randstadusa.com.
Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including health, an incentive and recognition program, and 401K contribution (all benefits are based on eligibility).
This posting is open for thirty (30) days.
get in touch
we are here to help you with your questions.
DN
deepa nuchu
+1 995 921 5414 (tel:+1 995 921 5414)
deepa.nuchu@randstadusa.com