Intake Representative I

Ignite HR Solutions; Palm Desert (CA); On-site; USD 28,000 - 34,000; Full time

Job summary

River’s Edge Pharmacy, a leader in infusion therapy services, seeks a detail-oriented professional to process new referrals and refill specialty prescriptions, coordinating between doctors, patients, insurance, and the pharmacy.

The role requires handling benefits verification, pre-authorization follow-up, and appeals while maintaining strong communication with patients and teammates. A background in specialty pharmacy is preferred, full-time position with growth opportunities.

Qualifications

• Thorough knowledge of Specialty Pharmacy laws and regulations.
• Proficient with Microsoft Office Suite or related software.
• Excellent verbal and written communication skills.
• Excellent interpersonal, negotiation, and conflict resolution skills.
• Excellent organizational skills and attention to detail.
• Strong analytical and problem-solving skills.

Responsibilities

• Communicate with patients to obtain information required to process prescriptions, refills, access benefits and apply charges against co-pay cards, and build trusted and enduring customer relationships.
• Investigate and verify benefits for pharmacy and medical third party claims for assigned cases.
• Follow up with Pre-Authorization team to provide additionally required information, track progress, and maintain contact with customers to keep them continuously informed.
• Facilitate appeals process between the patient, physician, and insurance company by requesting denial information.
• Compose clinical appeal letters based on specific denial reason and patient’s clinical presentation.
• Complete status check with insurance company regarding appeal and approval or denial status.
• Track, report, and escalate service issues arising from requests for authorizations, financial assistance or other issues.
• Build and maintain effective business relationships with prescribers treating assigned set of disease states.
• Complete assessments mandated by manufacturer contracts or operations.
• Review notifications of patients in need of financial assistance to cover the cost of their prescriptions.
• Obtain required information and permission from patients and submit electronic applications for financial assistance.
• Update all unfilled prescription activity status in the software every 48 hours.
• Ensure that work activities comply with the organization’s standards and procedures.

Skills

Communication skills

Interpersonal skills

Organizational skills

Analytical skills

Problem solving

Education

High school diploma or equivalent

Associate or Bachelor’s degree in healthcare or life sciences or business

Tools

Microsoft Office

Job description

Our client, River’s Edge Pharmacy, has become a leader in infusion therapy services. Administered by specially trained infusion nurses, these services are provided at standalone locations, physicians’ offices, or in the home of the patient. Each location provides individualized care in a private setting for procedures including IVIG, Hemophilia, Chemotherapy, TPN, and Pain Management.

Position Overview:

Perform duties related to the processing of new referrals and refill specialty prescriptions. They will be responsible for fostering the relationship between doctors, patients, insurance, and the pharmacy. They will have a working knowledge of the specialty prescription life cycle and the intake team’s role in the cycle.

Primary Responsibilities:

• Communicate with patients to obtain information required to process prescriptions, refills, access benefits and apply charges against co-pay cards, and build trusted and enduring customer relationships that yield loyalty.
• Investigate and verify benefits for pharmacy and medical third party claims for assigned cases. May communicate with financial assistance team of drug manufacturers to apply for and secure financial assistance for patient when assigned.
• Follow up with Pre-Authorization team to provide additionally required information, track progress, and maintain contact with customers to keep them continuously informed.
• Facilitate appeals process between the patient, physician, and insurance company by requesting denial information.
• Compose clinical appeal letters based on specific denial reason and patient’s clinical presentation. Ensure all clinical information and documentation are obtained prior to appeal submission. Coordinate appointment of representative document with patient and physician office.
• Complete status check with insurance company regarding appeal and approval or denial status. Obtain approval information and activate copay cards based on eligibility and specific drug prescribed.
• Track, report, and **escalate** service issues arising from requests for authorizations, financial assistance or other issues that delay service, to ensure patient access and to avoid delays that may interrupt therapy.
• Build and maintain effective business relationships with prescribers treating assigned set of disease states and provide ongoing communication of specific case-related information as appropriate.
• Complete a series of assessments mandated by either manufacturer contracts or operations. Facilitate patient enrollment with manufacturer hubs when required.
• Review notifications of patients in need of financial assistance to cover the cost of their prescriptions. Communicate with patients to provide information regarding assistance programs and community resources that provide the required assistance.
• Obtain required information and permission from patients and submit electronic applications for financial assistance on their behalf, or provide patients with forms required by assistance providers. Follow up with patients and assistance providers on status of claim to avoid interruption in therapy.
• Update all unfilled prescription activity status in the software every 48 hours.
• Ensure that work activities comply with the organization’s defined standards and procedures, and in a manner that provides the best available level of service and quality.

Plus – may perform other duties as assigned.

Education:

• High school diploma or equivalent required
• Associate or Bachelor’s degree in healthcare, life sciences, or business preferred

Experience:

• 1 or more years prior Pharmacy or experience.
• 1 or more years prior experience with Specialty or Infusion Pharmacy medications.

Technical / Specialized Knowledge, Skills Abilities

• Thorough knowledge of Specialty Pharmacy laws and regulations.
• Proficient with Microsoft Office Suite or related software.
• Excellent verbal and written communication skills.
• Excellent interpersonal, negotiation, and conflict resolution skills.
• Excellent organizational skills and attention to detail.
• Strong analytical and problem-solving skills.
• Ability to prioritize tasks and to delegate them when appropriate.
• Ability to act with integrity, professionalism, and confidentiality.

Working Conditions:

• This is a full-time position in a professional office environment.
• The role requires prolonged periods of sitting, frequent use of a computer and other standard office equipment, and occasional lifting of up to 20 pounds.
• Regular attendance and punctuality are essential. Some evening or weekend work may be required based on business needs.

Equal Opportunity Employer:

We are an equal opportunity employer committed to diversity and inclusion. We celebrate diversity and are dedicated to fostering an inclusive environment for all employees.

Job Type:

Full-time

Salary:

$20.00 - $25.00 per hour

Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.