Hybrid Pharmacy Benefits Specialist

Actalent; Garner (NC); Hybride; USD 32 000 - 33 000; Plein temps

Résumé du poste

Actalent is seeking a Patient Benefit Representative in Garner, NC to manage prescription insurance data, resolve claim issues, and coordinate access and delivery. The role requires strong pharmacy operations experience and superb customer service in a fast-paced setting.

You will handle eligibility checks, adjudicate claims, and communicate with providers and patients about prior authorizations and payment options, while maintaining meticulous documentation in patient profiles.

Qualifications

• Prior experience working in a pharmacy setting is required.
• 2+ years of pharmacy operations experience, including claims processing, is preferred.
• Demonstrated experience with data entry in a healthcare or pharmacy environment.
• Strong customer service skills with the ability to handle inbound calls from patients and healthcare professionals.
• Excellent organizational and time management skills to manage multiple tasks and priorities.
• Competency in basic computer skills, including use of standard office and pharmacy-related systems.
• Ability to multitask effectively while maintaining accuracy and attention to detail.
• Strong interpersonal skills with the ability to work effectively with patients, providers, and colleagues.
• Conscientious, detail-oriented approach to documentation and patient record management.
• Flexibility and adaptability to changing processes, team needs, and program requirements.
• High school diploma is required.

Responsabilités

• Locate and enter accurate prescription insurance information into patient profiles by processing eligibility checks and adjudicating pharmacy claims.
• Resolve claim issues and troubleshoot rejections to ensure correct information is communicated to patients and their medications can be processed successfully.
• Communicate the need for medication prior authorizations to providers and serve as a resource throughout the prior authorization process.
• Manage inbound calls from patients, clients, physicians, practitioners, and clinics regarding order status, services provided, and available financial support options.
• Serve as a technical resource on claim adjudication processes and identify areas for improvement in workflows and procedures.
• Enter detailed, accurate, and grammatically correct progress notes to maintain complete and compliant documentation in patient profiles.
• Contact patients to schedule medication delivery and payment, ensuring that accurate information is recorded so distribution can ship orders in a timely manner.
• Coordinate and manage patient refills and follow-up to support adherence to prescribed therapy plans.
• Identify and report adverse events and product complaints to clinicians to help ensure patient safety.
• Perform other related duties as assigned, with tasks varying slightly depending on the specific team or program.

Connaissances

Pharmacy experience

Pharmacy operations

Data entry

Customer service

Organization

Time management

Computer skills

Multitasking

Interpersonal skills

Documentation

Adaptability

Attention to detail

Formation

High school diploma

NCBOP registration preferred

Description du poste

Actalent is seeking a Patient Benefit Representative in Garner, NC to manage prescription insurance data, resolve claim issues, and coordinate access and delivery. The role requires strong pharmacy operations experience and superb customer service in a fast-paced setting.

You will handle eligibility checks, adjudicate claims, and communicate with providers and patients about prior authorizations and payment options, while maintaining meticulous documentation in patient profiles.