Performs patient onboarding, benefit verification, prior authorization, financial assistance and appeals processes, as needed, on behalf of patients and their physician to facilitate the process between the doctors' office and pharmacy to triage and streamline prescription fulfillment.
Provides above services for a health system's ambulatory pharmacy, specialty pharmacy and/or outpatient infusion center environment, as requested.
Interacts with patients and providers to obtain insurance benefits and patient information needed to request prior authorizations so that medications and other services rendered are reimbursed by payer.
Ensure patient-specific reimbursement related information is obtained and available for review and for tracking of replacement product, including maintenance of files and documentation for PAP application submissions.
Obtains appropriate signatures and documentation for completed PAP applications prior to submission of the application to the respective PAP.
Completes patient adherence activities that may include notification of upcoming refills, coordination, tracking, and confirmation of prescription delivery.
Works within health system's electronic medical record system and other applicable systems (i.e., IndiCare™) to support workflow management and to document activities (i.e., retrieve information needed to deliver services, communicate status, and document outcome).
Provides integrated services to the health system and its component parts to increase prescription capture rate, ensure timely delivery of infusion medications to be infused in the hospital setting, improve patient outcomes and reduce readmissions.
Resolves barriers proactively that may affect reimbursement at assigned facilities and provides detailed updates to the Patient Access Management team.
Establish business relationships with assigned clinic staff, pharmacy, and hospital contacts, keeping them informed of significant changes in site-specific recovery potential based on changes to PAPs.
Readily assists on special projects within job scope to improve reimbursement optimization when requested by management.
Communicates patient and provider feedback to PHS management to enhance process improvement to enhance continuity of care.
Interfaces appropriately with assigned key account associates with information relevant to additional products and services provided by Cencora and its subsidiaries.
Demonstrates flexibility and adapts to changes in payer, pharmacy and patient assistance program processes and requirements.
Provides temporary coverage to support clients and patients in the event of onsite resource absences.
Performs related duties as assigned
Education:
Pharmacy Technician Certification Board (PTCB) certification is required.
Skills and Knowledge:
Ability to communicate effectively both orally and in writing.
Strong organizational skills; attention to detail
Ability to work quickly and accurately under time and volume constraints.
Ability to be proactive and tenaciously seek solutions under minimum supervision to improve
customer satisfaction.
Demonstrated competence in Microsoft E
Benefits
Health insuranceVision insuranceRemote work options
Additional Information
Our team members are at the heart of everything we do. At Cencora, we are united in our responsibility to create healthier futures, and every person here is essential to us being able to deliver on that purpose. If you want to make a difference at the center of health, come join our innovative company and help us improve the lives of people and animals everywhere. Apply today!
Job Details
The Patient Services Specialist I is responsible for initiating, researching, completing, submitting, and tracking Patient Services Program applications
for assigned facilities. The incumbent is responsible for conducting benefit verification and completing necessary third-party prior authorizations, reimbursement activities, patient assistance, and copay program enrollments. They may also coordinate refill calls, perform documented adherence activities,
and coordinate dispensing for specialty medications, high-cost prescriptions, and/or infusion medications for both the pharmacy and medical benefit. This role requires proactive interaction with facility staff, patients, payers, and patient assistance programs (PAP). May need to adjust work schedule to support customers in different time zones.
Location : Remote
Hours : Mirror clinic hours (Monday through Friday 8:30 am to 5 pm) in either EST, CST, or MT time zones
Required : CPhT certification
Myhrabc · Remote