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This job is Filled
Sterling, VA
Full Time, Hourly, Non-Exempt, Part Time
- Job Nature: Hybrid Remote Office based desk position, Heavy phone and computer usage, minimal lifting.
- Job Summary: Increased activity of a patient support hub program to which the employee is assigned. Includes researching and analyzing moderate to complex reimbursement policies and procedures. May include interaction with senior level client, vendors, pharmacists, pharmacy staff. May also include handling of escalated cases/issues including pharmacy rejections, pharmacies out of stock.
- Job Duties: Individual must have the ability to calibrate and work closely with internal and external stakeholders including providers, payers, PBMs. This individual must knowledge of pharmacy rejections or previously been a pharmacy technician. Must have strong communication skills and can build relationships with sales representatives, respond to matters immediately and have attention to detail as well as be solution oriented. Handle inbound calls from sales field inquires. Other duties include reviewing case managers cases to be sure notes are clear and concise and reportable. Subject matter expert on pharmacy rejections, access pathways and SPOC (single point of contact) for all client partnered pharmacies providing home delivery to patients. Ability to address pharmacies and determine coverage with the Rx/NPI number assigned to specific rejected claims. Determine the method and source of the prescription and exchange information between external partners within a portal and CRM. Identify and assess patient specific insurance coverage prior to triaging the prescription to a retail or specialty pharmacy options for client specific products. Document all activities in program CRM database within required timelines. Use of accurate subjects, notes, templates is a must. Research payer, plan name and payer types are critical for reporting purposes. Monitor and update payer prior authorization requirements and coverage policies for specified client program. Prepare and/or assist with preparation of specific reports. Review and process documentation to determine patient specific eligibility for client patient assistance program(s), as appropriate. Host conference calls with senior level client and or attend QBRs.
- Training, Education, Experirnce: Data analytical skills. Advanced communication skills, both written and verbal Complete quality monitoring and quality assurance activities, as assigned. Travel to and attend client meetings, off site training, Data entry accuracy required. Ability to multi-task and manage time independently. Client interaction experience preferred. Bilingual a plus.
- Job Relationships: Works with varying levels of staff and in direct client and consumer contact.
- Time Commitment: Monday through Friday Shift schedule may vary Minimum 40 work hours Full Time, Maximum 30 work hours Part Time.
- Hybrid Remote: This job combines on-site at a specific address in Sterling, Virginia with some remote flexibility.