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This job is Filled
Sterling, VA
Full Time, Hourly, Non-Exempt, Part Time
- Job Nature: 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 and vendors. May also include handling of escalated cases/issues. Subject Matter Experts (SMEs) for a specific region or territory and have strong knowledge and understanding of payer landscape.
- Job Duties: Individual must have the ability to calibrate and work closely with internal and external stakeholders including providers, payers, PBMs. This individual must have the ability to build relationships with sales representatives, respond to matters immediately and have attention to detail. Other duties include reviewing case managers cases. Identifying opportunities to educate offices of prior authorizations submissions or inaccurate prior authorization submissions. Quality check cases to determine all efforts were made and executed timely. Review all PAP cases to determine if all efforts were exhausted. Other responsibilities may include acting as regional contact for senior level client contacts. Manage patient cases and interact with patients, healthcare providers, payers, and pharmaceutical and biotech manufacturer sales teams. Act as a back-up for PTO request. 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 contacts as required by program guidelines. Complete quality monitoring and quality assurance activities, as assigned. Travel to and attend client meetings, off site training, and/or conferences. Travel time estimate: 10%.
- Training, Education, Experience Requirements: Must be 18 years old or older. Bachelor’s degree or relevant experience. Minimum four years recent healthcare experience (2 years’ direct industry preferred). Advanced knowledge of medical insurance (public and commercial), billing and coding and associated terminology. Exhibit proficiency in Microsoft Office products. Excellent customer service skills (call center experience preferred). Advanced problem solving, research and analytical skills. Advanced communication skills, both written and verbal. Data entry accuracy required. Ability to multi-task and manage time independently. Client interaction experience preferred.
- Job Relationships: Works with varying levels of staff and in direct 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.
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