Care Coordinator

SMP Pharmacy Solutions LLC; Miami (FL); On-site; USD 40,000 - 60,000; Full time

Job summary

SMP Pharmacy Solutions LLC is seeking a patient access coordinator to assist patients with benefits, savings programs and scheduling delivery of specialty prescriptions via inbound/outbound calls and web inquiries.

You will obtain information to process prescriptions, verify benefits, obtain prior authorizations, coordinate with insurers and physicians, and ensure HIPAA compliance while delivering high-quality service.

Job description

Summary:

Perform duties to assist patients with access to benefits, savings programs and schedule delivery
of prescriptions provided through the specialty pharmacy via inbound and outbound calls and web
inquiries.

Essential Duties and Responsibilities:

• 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 patients/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 specific denial reason and patients clinical
• presentation. Coordinate appointment of representative document.
• Complete status check with insurance company regarding receipt/outcome of prior
• authorization and appeal. Obtain approval information and activate copay cards based off
• eligibility and specific drug prescribed.
• Track, report and escal 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
• pharmacy to confirm the prescription was received.
• Coordinate verbal transfer by a Pharmacist if specialty pharmacy has no record of
• prescription. Confirm with patient that prescription was received from alternate pharmacy.
• Complete a series of assessments mandated by either manufacturer contracts or
• operations and facilitate patient enrollment when required.
• Document case activity, communications, and correspondence in computer system to
• Ensure completeness and accuracy of patient contact records while ensuring HIPAA practices.
• Ensure that work activities are conducted in compliance with regulatory requirements and the company' s defined standards and procedures, and in a manner that provides the best available level of service and quality.
• Collaborate with multiple departments in a customer service / call center setting.
• Perform other related duties as assigned.