Provides expertise on insurance coverage and common access and reimbursement challenges affecting patients, healthcare providers and clients
The responsibilities include education on access and reimbursement support tools and the participating program, advising healthcare providers (HCP's) and/or patients and caregivers on the benefits and program eligibility for a specific patient, and educating HCP offices on payor processes and procedures
Builds trusted relationships with patients, prescribers, client stakeholders through proactive communication, timely and accurate execution of deliverables and demonstrated relentless passion for helping patients
Managing all relationships in a manner that adheres to all relevant laws, regulations, program-specific operating procedures and industry standards related to access and affordability, including HIPAA and insurance guidelines
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 all client inquiries as appropriate, such as specific case statuses
Manages all HCP inquiries, as applicable, pursuant to business rules
All communications with the client's field teams will remain compliant and adhere to ways of working protocols
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
Compassionately deliver an exceptional experience to many patients per day always remembering that every prescription or document belongs to a real person who is looking for thorough efficient management of their records
Adjust your approach to their needs by communicating clearly, focusing on the accuracy of the details of their medical records and your mastery of the program requirements, and ensuring their prescriptions or cases are handled timely
Reporting of Adverse Events/Product Complaint inquiries received in accordance with SOP and good manufacturer practices
Effectively uses internal technology platform to complete claims processing and keep workflows moving
Communicate with key medical practice accounts, sales representatives regarding the status of cases
Provide consultative services where issues arise on how obstacles can be overcome to get patient on paid therapy
Payer benefits experience, reimbursement, or prior authorization experience required
Must be available for an 8-hour shift between 8:00 AM – 8:00 PM
BENEFITS:
Toll Reimbursement Program (valued at $678.60/annually)
Company paid Short-term Disability (STD)
Increased competitive 401(k) company match up to 4%
Affordable Medical, Dental, and Vision benefits
Concierge Medical Clinic free of cost for those enrolled
Wellness discounts of up to $260 per year for participation in wellness program
Annual HSA employer contribution
Company paid and voluntary Life Insurance options
Voluntary Life, AD&D and Long-Term Disability Insurances
Paid Parental Leave of Absence
Wellness and Employee Assistance Programs
PTO benefits, flex days and paid holidays
Employee Referral Program
Ambassador Program
Tuition reimbursement program up to $5,000 per year
About TEKsystems:
We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
