Pharmacy Intake Coordinator

Specialty Care Rx; Orange (CA); On-site; USD 45,000 - 75,000; Full time

Job summary

Join a dynamic team at an established industry player where your skills in patient communication and insurance management will shine. In this role, you will be the vital link between patients and insurance providers, ensuring that prescriptions are processed smoothly and efficiently. You'll manage prior authorizations, handle appeals, and maintain compliance with regulatory standards, all while providing top-notch service. This is an exciting opportunity to make a real difference in patients' lives while working in a supportive environment that values your contributions and fosters your professional growth.

Qualifications

• Strong communication skills to interact with patients and insurance companies.
• Experience in managing prior authorizations and insurance claims.

Responsibilities

• Communicate with patients to process prescriptions and verify insurance benefits.
• Facilitate the appeals process and document all case activities accurately.

Skills

Patient Communication

Insurance Verification

Prior Authorization Management

Clinical Appeals Composition

Regulatory Compliance

Tools

Computer System for Documentation

Job description

Description

Roles 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 insurance benefits and eligibility 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 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 on specific denial reason and patient’s clinical presentation and 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 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.
• Notify patients when their prescription has been transferred and follow up with specialty pharmacy to confirm the prescription was received (in some jurisdictions).
• Coordinate verbal transfer by a pharmacist if specialty pharmacy has no record of prescription (in some jurisdictions); confirm with patient that prescription was received from alternate specialty pharmacy.
• Complete a series of assessments mandated by either manufacturer contracts or operations and facilitate patient enrollment with manufacturer Hubs when required.
• Document case activity, communications, and correspondence in computer system to ensure completeness and accuracy of patient contact records.
• Ensure that work activities are conducted in compliance with regulatory requirements and the organization defined standards and procedures, and in a manner that provides the best available level of service and quality.
• Perform or assist with any operations, as required to maintain workflow and to meet business needs.
• Must be able to perform the essential job functions of this position with or without reasonable accommodation.
• Participate in any variety of meetings and work groups to integrate activities, communicate issues, obtain approvals, resolve problems, and maintain specified level of knowledge pertaining to