- Investigate and verify insurance coverage for patient medication requests under pharmacy and medical benefit types.
- Request coverage determinations from payors on patient requests that have utilization management requirements.
- Collaborate with providers in obtaining necessary information on patient, medication request, insurance details and any clinical documentation required.
- Contact new patients or their caregivers to review service offering of our clinical programs and monthly refill coordination, obtain copay/balance, AOB or other pertinent outstanding information needed to keep on patients record.
- Ensure full customer satisfaction and maintain a friendly, helpful demeanor.
- Refer unresolved account issues to designated departments for further investigation.
- Log into phone queue and support callers (patients/physicians; etc.) needs.
- Provide all inbound callers with information regarding our products or services, take or enter orders, cancel orders or obtain details of complaints.
- Review with existing patient’s or caregivers their medication coverage, obtain copay/balance, AOB or other pertinent outstanding information needed to keep on patients record.
- Document all communications, details of inquiries and actions taken in patient record.
- Transfer patient or provider to clinician for additional assessments as needed and/or required.
- Process payments in the form of credit card transactions and inform patients of past due amounts.
MINIMUM KNOWLEDGE, SKILLS AND ABILITIES REQUIRED:
The requirements listed below are representative of the knowledge, skill and/or ability required.
- Excellent oral communication skills
- Time management
- Active listening
- Complex problem solving
- Critical thinking
- Judgement & decision making
- >3+ years of related healthcare experience in Specialty Pharmacy setting or 5+ years of customer service experience in a call center environment
- High sense of urgency
- Commitment to excellence
- Patient focused
- Empathetic and respectful
- Dedicated and persistent
- Cooperative and knowledgeable
- Strong organizational and interpersonal skills
- Ability to work well under pressure in a fast-paced work environment and under tight deadlines
TOOLS AND EQUIPMENT USED:
Pharmacy computer system, web-based payer platforms.
To perform this job successfully, an individual must be able to meet and exceed industry standards in all duties as outlined above. Failure to do so may result in disciplinary action; up to and including termination of employment.
The above statements describe the general nature and level of work only. They are not an exhaustive list of all required responsibilities, duties, and skills. Other duties may be added, or this summary amended at any time.
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