Associate Case Manager

Key Responsibilities

Verify and re-verify insurance coverage policies and benefit details through direct contact with payers
Receive incoming referrals from providers, via fax queue (or other means)
Maintain workflow of clearing, sorting, and distribution of incoming faxes
Ability to prioritize work duties to maintain customer satisfaction through prompt and efficient service
Accurately interprets patient insurance, prescription, and other health related documentation
Enter and maintain accurate data on individuals, their insurance, and all payer interactions
Send Summary of Benefits to Providers and Field Reimbursement Directors
Research and identify payer Prior Authorization Processes and obtain necessary documents and requirements to disseminate to Case Management Team
Submit and Track referrals to Specialty Pharmacies, as needed
Maintain up-to-date knowledge of the reimbursement process, billing/coding guidelines, healthcare policy, payer trends
Participate in projects and/or assignments including, but not limited to, QC initiatives, interdepartmental projects, etc.
Demonstrate adaptability and flexibility; seek out opportunities to support your teammates
Navigate customer-relationship management (CRM) platform in daily interations and learn internal team processes for full understanding of Alnylam’s Patient Services
Maintain confidentiality of patient health information and act in compliance with all laws, regulations, and Alnylam Company policies
Outreach to Sites of Care related to initial and ongoing treatment

Qualifications

Bachelor’s Degree required
1-2 years of experience with customer service, account management, case management, or healthcare field experience
rare disease experience preferred
Knowledge of private payer, Medicare, and Medicaid structure, systems, reimbursement process and medical terminology
Experience working in a high-volume patient services program preferred
Effective communication, ability to think critically and problem solve
Willingness to learn and adapt quickly in a fast-paced environment
Ability to work cooperatively as a team member and have well-developed interpersonal skills
Self-starter who is highly passionate about rare disease and Alnylam’s core values:
Commitment to People, Innovation, Discovery, Sense of Urgency, Open Culture, and Passion for Excellence