If you like healthcare admin work that has clear lanes (benefits, prior auth, payer calls, documentation), this is your kind of role. It’s reimbursement hub work, which means details and follow up are the whole game.
About CareMetx
CareMetx supports the patient journey through hub services, technology, and data for pharmaceutical, biotechnology, and medical device innovators.
Schedule
Remote
Must be flexible on schedule and hours
Overtime may be required at times
Weekends may be required to meet company demands
What You’ll Do
- Conduct benefit investigations and collect insurance benefit information (per program SOP)
- Support prior authorizations: submit forms, track status, and follow up with payers
- Assist physician offices and patients with insurance forms and program applications
- Triage provider account inquiries and maintain frequent phone contact with providers, payers, and pharmacies
- Document all provider, payer, and client interactions in the CareMetx Connect system
- Compile required information to expedite PA requests (demographics, referrals/authorizations, NPI, referring physician details)
- Identify and report reimbursement trends or delays to your supervisor
- Process insurance and patient correspondence as needed
- Coordinate across internal teams to move cases forward
- Escalate complaints appropriately and deliver strong customer service
- Report Adverse Events (AE) per training and SOP
- Handle moderate-scope issues using judgment within SOP guidelines
- Take on other duties as assigned as programs evolve
What You Need
- High school diploma or GED (required)
- 1+ year experience in specialty pharmacy, medical insurance, physician office, healthcare setting, or related environment
- Strong verbal and written communication skills
- Ability to build strong internal and external working relationships
- Solid negotiating skills and customer service instincts
- Strong organization and attention to detail
- Working knowledge of pharmacy and medical benefits
- Understanding of commercial and government payers (preferred)
- Proficiency in Microsoft Excel, Outlook, and Word
- Ability to work independently and as part of a team
- Problem solving and strong time management
Benefits
Not listed in the posting.
Compensation
$30,490.45 – $38,960.02 (posted range)
Fast action move: if you’re applying, your resume needs to say “benefit investigations,” “prior authorizations,” “payer follow up,” and “documentation in CRM/system” in plain language. If you paste your current resume bullets for your most relevant role, I’ll rewrite them to match this job’s keywords without sounding corny.
Happy Hunting,
~Two Chicks…