case manager.

The Case Manager is responsible for working closely with healthcare providers, patients and drug manufacturer's programs managing complex reimbursement issues. 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.  Must be able to work ONSITE.   Qualifications:

• High School Diploma or Equivalent
• 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.
• 2+ years’ customer service experience and 2+ years’ medical or insurance industry experience.
• Excellent communication and organizational skills.
• Excellent problem solving and decision-making skills and ability to effectively handle multiple priorities.

salary: $23.99 - $24 per hour
shift: First
work hours: 8 AM - 5 PM
education: High School

Responsibilities

▪ Work with healthcare providers and patients to assist with appeal management for
claim denials.
▪ Work with physicians and payers to advocate for product specific coverage. Ability to
communicate product benefits and efficacy to positively influence payer policy.
▪ Capability to monitor drug coverage policies for multiple payers. Review case
outcomes to analyze and identify payment and denial trends as well as key findings
for client reporting.
▪ Ability to effectively respond to escalated issues and complex cases referred 




Skills

Answering Phones

Decision Making

Microsoft Office

Healthcare

Customer Service

Claims

Qualifications

Years of experience: 5 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: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).

This posting is open for thirty (30) days.