Working at Horizon Therapeutics is more than a job - it's personal. We define success by a different set of numbers: the number of lives touched, the number of lives changed, the number of lives saved. We're a team of agile, out-of-the-box thinkers who are inspired to do more because we know we're a part of something bigger. We strive to build meaningful careers at a company whose values we share because when we live up to our potential, we help patients live up to theirs.
The Associate Case Manager works in a highly visible, team and collaborative environment working with the reimbursement HUB, Patient Access Managers (PAMs) and Specialty Pharmacy. This position is responsible for the data entry of new referrals and imaging of clinical documentation across multiple brands into the data management platform. The Associate Case Manager must be able to identify missing information on referrals in a timely manner and effectively communicate to pertinent stakeholders. The Associate Case Manager will also be responsible for assisting Case managers across multiple brands. The Associate Case Manager must be able to support regional geographies and time zones.
* Help to ameliorate patient customer service issues with insurance, the specialty pharmacy, and patient support programs to ensure continued access to therapy * Serve as initial reviewer in the intake process, triaging, troubleshooting and determining the appropriate path to resolve reimbursement issues (PAs, denials, appeals, reauthorizations, overrides, billing problems); responsible for elevating issues and engaging multiple cross functional stakeholders based on area of expertise * Support the critical elements of payer correspondence, including but not limited to, interpretation of denial letters and the review of supporting documentation; identify and ameliorate pertinent lab values in medical records as well as trial and failure of step edit therapy * Partner with Case Managers across brands to communicate problems; ensure timely resolution and persistency of support * Liaise with medical offices as necessary to obtain insurance authorizations and gather missing information * Act as Interim Case Manager during reverification process and other periods of high volume (i.e., support oversight and awareness of patient customer service issues with insurance, the specialty pharmacy, and patient support programs) * Responsible for the day-to-day entry of all source documents within time limits * Transfer data from paper formats into computer files or database systems * Review data for completeness, deficiencies and/or errors * Compile, verify for accuracy and sort information to prepare source data for computer entry * Respond to queries for information and access relevant files * Maintain confidentiality pertaining to patient health information; comply with data integrity and security policies * Support ad hoc projects and tasks
Qualifications and Skills Required:
* Bachelor's degree required * 4+ years' related work experience * Scientific or nursing background a plus * Must have a deep knowledge of Reimbursement HUB and Specialty pharmacy procedures, including eligibility and benefits investigations, pharmacy clearance, and utilization of overrides * Prior experience in healthcare and/or pharmaceutical industry is a plus * Excellent communication skills and commitment to customer service * Strong attention to detail * Exceptional organizational skills; ability to multi-task and self-prioritize workload in a fast-paced environment * Strong grammar, proofreading and typing skills * Ability to work independently, facilitate appropriate judgment in decision making as well as function as a team player * Proficient in Word and Excel * Professional demeanor * Up to 20% travel required * Ability to learn product and disease information, familiarity with HIPAA and FDA
Horizon Therapeutics plc does not discriminate on the basis of race, color, religion, gender, sexual orientation, national origin, age, disability, veteran status, or any other characteristic protected by law. It is our intention that all qualified applications are given equal opportunity and that selection decisions be based on job-related factors. Any individual, who, because of a disability, needs accommodation or assistance in completing this application or at any time during the application process, should contact the Human Resources Department.
Associated topics: business development, case manager, development, development manager, liaison, project, program management, project development, project management, resource development
* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.