Patient Access Coordinator – Remote After Training – Lake Mary, FL

POSITION SUMMARY -Perform duties to assist patients with access to benefits and co-pay cards, and schedule delivery of prescriptions provided through the specialty pharmacy, working within the limits of standard or accepted practice. -Demonstrate the company’s core values of respect, honesty, integrity, diversity, inclusion, and safety. ESSENTIAL JOB FUNCTIONS -Communicate with patients to obtain information required to process prescriptions, refills, access benefits and apply charges against co-pay cards -Investigate and verify benefits for pharmacy and medical third-party claims for assigned cases -Obtain prior authorizations; initiate requests, track progress, and expedite responses from insurance carriers and other payers, and maintain contact with customers to keep them continuously informed -Review for accuracy of prescribed treatment regimen prior to submission of authorization -Facilitate appeals process between the patient, physician and insurance company; compose clinical appeals letters based off of specific denial reason and patient’s clinical presentation and coordinate appointment of representative document -Complete status check with insurance company regarding receipt/outcome of prior authorization and appeal; obtain approval information and activates copay cards based off of eligibility and specific drug prescribed -Track, report and escalate service issues arising from requests for authorizations, financial assistance or other issues that delay service -Notify patients when their prescription has been transferred and follow up with specialty pharmacy to confirm the prescription was received (in some jurisdictions) -Coordinate verbal transfer by a pharmacist if specialty pharmacy has no record of prescription (in some jurisdictions); confirm with patient that prescription was received from alternate specialty pharmacy -Complete a series of assessments mandated by either manufacturer contracts or operations and facilitates patient enrollment with manufacturer Hubs when required -Document case activity, communications and correspondence in computer system to ensure completeness and accuracy of patient contact records -Ensure that work activities are conducted in compliance with regulatory requirements and the organization’s defined standards and procedures, and in a manner that provides the best available level of service and quality -Perform or assist with any operations, as required to maintain workflow and to meet business needs -Perform other related duties as assigned -Must be able to perform the essential job functions of this position with or without reasonable accommodation MINIMUM POSITION QUALIFICATIONS -High School Diploma or GED -1 year of proven work experience in a healthcare or customer service industry -Superior telephone customer service skills -Strong organization skills as well as attention to detail -Excellent knowledge of insurance benefit investigation process and techniques -Demonstrated ability to manage a range of priorities and meet time commitments -Excellent data management software skills with demonstrated adaptability to internal systems -Demonstrated strength in listening, oral and written communications in English DESIRED PREVIOUS JOB EXPERIENCE/EDUCATION -Any additional training in pharmacy/medical benefit access and requirements -Any healthcare experience with a basic understanding of clinical terms and benefits investigation -Any previous experience in a call center preferred where performance was measured -Pharmacy Technician Certification