Specialty Pharmacy Intake Specialist

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

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.