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IQVIA Care Manager in Northborough, Massachusetts

Care Managers are responsible for contacting insurance companies to obtain correct eligibility information, perform benefit investigations, copay assistance and check prior authorization and/ or appeal status. This is a remote position. Employees will receive all necessary equipment to work from home. This will include a laptop with docking station, 2 monitors and a softphone. All remote employees are responsible for maintaining equipment and returning equipment if employment ends.

The information contained herein is intended to be an accurate reflection of the duties and responsibilities of the individuals assigned to this position. They are not intended to be an exhaustive list of the skills and abilities required to do the job. AllCare Plus Pharmacy reserves the right to revise the job or to require that other or different tasks be performed as assigned.

Primary Responsibilities:

  1. Responsible for answering in-bound calls and assisting customers with pharmacy related services

  2. Obtain client information by answering telephone calls; interviewing clients; verifying information

  3. Contact insurance companies for benefit investigation and coverage eligibility

  4. Complete prior authorizations with attention to detail and accuracy, to then have the prepared prior authorization reviewed by a clinical pharmacist

  5. Assist patients with the enrollment process for manufacturer and non-profit organization copay assistance programs

  6. Provide customers with courteous, friendly, fast and efficient service

  7. Update job knowledge by participating in educational opportunities and training activities.

  8. Work efficiently both individually and within a team to accomplish required tasks

  9. Maintain and improve quality results by adhering to standards and guidelines and recommending improved procedures

Required Qualifications:

  1. High School Diploma or equivalent, some college preferred

  2. Minimum one year experience in medical billing, insurance verification, or similar related medical office experience

  3. Previous data entry experience (minimum three months) and ability to type 30wpmPreferred Qualifications:

  4. Customer Service experience

  5. Bilingual (Spanish) highly desirable

  6. Ability to use MS Office

Professional Competencies:

  1. Business Skills and Knowledge

• General Management

Demonstrate analytic and problem solving skills, and understand the impact of individual

decisions on other parts of the organization and the environment.

• Quality improvement

Application of techniques that continually improve the quality of care provided, patient

safety, organizational performance, and the financial health of the organization.

  1. Knowledge of the Health Care Environment

• Health Care Systems and Organizations

Demonstrate an understanding of how the various components of the health care

system is organized and financed, and how they interact to deliver medical and health

care.

• The Patient’s Perspective

Understand the patient experience, demonstrate a commitment to patients’ rights and

responsibilities, and ensure that the organization provides a safe environment for

patients and their families.

  1. Communication and Relationship Management

• Relationship Management

The ability to build and maintain relationships with internal as well as external

stakeholders that are anchored in trust and where decision-making is shared.

• Communication Skills

Be able to utilize verbal, written and presentation skills to communicate an

organization’s mission, vision, values and priorities to diverse audiences.

  1. Professionalism

• The ability to align personal and organizational conduct with ethical and professional standards

that include a responsibility to the patient and community, a service orientation, and a

commitment to lifelong learning and improvement

IQVIA is a leading global provider of advanced analytics, technology solutions and clinical research services to the life sciences industry. We believe in pushing the boundaries of human science and data science to make the biggest impact possible – to help our customers create a healthier world. Learn more at https://jobs.iqvia.com

We are committed to providing equal employment opportunities for all, including veterans and candidates with disabilities. https://jobs.iqvia.com/eoe

As the COVID-19 virus continues to evolve, IQVIA’s ability to operate and provide certain services to customers and partners necessitates IQVIA and its employees meet specific requirements regarding vaccination status. https://jobs.iqvia.com/covid-19-vaccine-status

EEO Minorities/Females/Protected Veterans/Disabled

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