Pittsburgh, Pennsylvania
Duties/Responsibilities:
- 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 prior authorization requirements.
- Qualify patients for any quick start, bridge, or patient assistance programs as necessary
- Support patient copay program and other financial assistance needs, as necessary
- 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.
- Log into phone queue and support callers (patients/prescribers/caregivers; etc) needs.
Required Skills / Abilities
- Complex problem solving
- Expertise in critical thinking
- Excellent oral communication skills
- Strong skills in time management, active listening, and expertise in judgement & decision-making
- Active listening
- ScriptMed CRM experience a plus!
Qualifications:
- >3+ years of related healthcare experience in Specialty Pharmacy setting with at least 1 year in Insurance Verification, PA or Reimbursement services
- High sense of urgency
- Excellent problem-solving skills
- Cooperative and knowledgeable
- Ability to work well under pressure in a fast-paced work environment and under tight deadlines
- Ability to work weekdays, including possible Saturdays and extended business hours, as needed
Position Success Factors:
- Excellent problem-solving skills
- Contribute to delivering a positive engagement with all internal teams
- Ability to work well under pressure in a fast-paced work environment and under tight deadlines
- Strong communication skills; clear and concise, effective, patient, and courteous.
- A solid base understanding of operational roles within a Specialty Pharmacy setting
About Perigon Pharmacy 360
Perigon Pharmacy 360 is a national, independent pharmacy with dual accreditation from URAC + ACHC and one location in Pittsburgh PA. Founded in 2016 as a specialty pharmacy, we have continued to keep our personal touch at the forefront of all we do for patients, providers, and our partners in excellence. In 2021, we re-focused efforts to evolve with the growing need of embracing technology by bridging the gap between Digital Pharmacy and Personal Care through our exclusive use of the Medesto Health Enterprise Platform, created and developed internally by Perigon Health 360. Our talented team of Pharmacists have developed clinical protocols to support the needs of multi-chronic and specialty patients, to help successfully guide the patient through their healthcare journey with meaningful results also for our payor and pharma partners. Come learn more about the exciting difference we are making in healthcare. Learn more about Perigon Health 360 here.