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Patient Access Coordinator- Pharmacy Technician License - Required

Department: JDMS Operations
Position Type: Employee
Position Reports To: Supervisor, Patient Access; Supervisor, Pharmacy Technician; Manager, Patient Access
Position Supervises: N/A
Pay Level: N/A
FLSA Status: N/A
 

 

Position Summary

Perform duties to assist patients with access to benefits and co-pay cards, and schedule delivery of prescriptions provided through the specialty pharmacy, working within the limits of standard or accepted practice. Demonstrate the companys core values of respect, honesty, integrity, diversity, inclusion, and safety.

Essential Job Functions

  • 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 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 of specific denial reason and patients 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 activates copay cards based off of 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 facilitates 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 organizations 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
  • Perform other related duties as assigned
  • Must be able to perform the essential job functions of this position with or without reasonable accommodation

    • Minimum Position Qualifications

  • High School Diploma or GED
  • 1 year of proven work experience in a healthcare or customer service industry
  • Superior telephone customer service skills
  • Strong organization skills as well as attention to detail
  • Excellent knowledge of insurance benefit investigation process and techniques
  • Demonstrated ability to manage a range of priorities and meet time commitments
  • Excellent data management software skills with demonstrated adaptability to internal systems
  • Demonstrated strength in listening, oral and written communications in English

    • Desired Previous Experience/Education

  • Pharmacy Technician Certification
  • Any additional training in pharmacy/medical benefit access and requirements
  • Any healthcare experience with a basic understanding of clinical terms and benefits investigation
  • Any previous experience in a call center preferred where performance was measured

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    Leadership Behaviors: Achieves Results through Teamwork, Coaches and Develops Others, Communicates Effectively and Candidly, Executes with Excellence, Leads Change and Innovation, Leads through Positive Influence, Provides Clear and Strategic Direction, Puts the Customer First. For more information on the Kroger Leadership Behavior model, click here.
     

    Education Level: High School Diploma/ GED Required
    Required Certifications/Licenses: Pharmacy Technician Certification
    Shift(s): [[mfield4]]
    Regions: Any


     

     

     


    Nearest Major Market: Orlando
    Job Segment: Medical, Pharmacy, Technician, Developer, Law, Healthcare, Technology, Legal

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