About the job
Job Description
- Builds trusted relationships with patients, prescribers, client stakeholders through proactive communication, timely and accurate execution of deliverables and demonstrated relentless passion for helping patients
- Managed through a contact center structure, this role supports outbound and inbound calls to patients, caregivers, specialty pharmacies and healthcare professionals.
- Performs post benefits investigation calls to patients and/or physicians explaining coverage options and next steps in the access journey
- Manages inbound calls as directed by the program-approved FAQ’s
- Triage patients to internal or external resources as appropriate
- Provides personalized case management to patients and HCP’s including outbound communication to HCP’s and patients to communicate benefits coverage and next steps in obtaining coverage
- Leverages electronic tool to identify benefits and payer coverage; completes manual benefit investigations as needed
- Identifies and communicates patients’ plan benefit coverage including the need for prior auth, appeal, tier exception, and/or formulary exclusions
- Uses electronic resources to obtain benefit coverage outcome and if needed ,outbound call to payers and healthcare providers to follow up on proper submission/or outcome
Preferred Skills & Qualifications
- High School Diploma
- 2 years of experience in insurance reimbursement, patient access, direct patient care and/or patient education required
- Medical terminology – strongly preferred
- 6 months of payer benefits experience (reimbursement, prior auth, etc), healthcare industry experience or healthcare related experience is required
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