Reimbursement Case Manager

Job overview

The Reimbursement Case Manager role is listed onsite in Coraopolis, PA. Compensation is not specified. The position works with patients, healthcare providers, manufacturers, specialty pharmacies, and internal operations and program management teams. The case manager coordinates pharmacy reimbursement and prescription access cases, guiding inquiries and escalations through benefits verification, prior authorization, appeals, and referral processing. The work helps patients access prescribed therapies in a timely manner while maintaining accurate case communication and service standards.

What you'll do

• Serve as primary contact and case manager for client and customer inquiries and escalations
• process benefits investigations and verifications, prior authorizations, and appeals
• coordinate with program operations and management
• collaborate with manufacturer representatives and healthcare provider offices
• manage prescription and medical benefit claims
• report payer trends and access delays
• process patient and prescriber requests
• maintain frequent phone contact
• support referral processing and resolve complex reimbursement issues.

What we're looking for

Skills & competencies

reimbursement case manager

pharmacy reimbursement

patient access

benefits verification

prior authorization

appeals

coraopolis pa

onsite

caretend

specialty pharmacy

patient support

summit access solutions

Work arrangement

• Weekend coverage required

Why this role

Requires a high school diploma or equivalent, two or more years of pharmacy reimbursement/insurance experience, two or more years of pharmacy case management experience, at least one year as a pharmacy technician, and at least one year using CareTend Pharmacy Management System.

About the employer

Summit Access Solutions,LLC is hiring for this role. Industry: All Other Miscellaneous Ambulatory Health Care Services. Sector: 62.