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Program Specialist
2 months ago
*Description:* In this position, contractors will support Inbound & Outbound calls and deal with complex benefits investigations to payers. They will be supporting patients who either need financial assistance for their medications, or are seeking approval for medications at no cost.
- -Responsible for serving as the customer’s primary point of contact providing operational and reimbursement support to complex programs.
- -Own issues and remove obstacles that prevent patients or providers from accessing the therapies requested.
- -Be a self-starter who is comfortable taking initiative, identifying barriers, and working with the appropriate parties to eliminate these obstructions for the customer.
- -Proficient and knowledgeable about all the services provided on an assigned program and may support multiple client products or programs.
- -Must be disciplined with the ability to speak with customers, sit and talk for long stretches.
- -Quickly and efficiently respond to incoming calls and faxes, identify how best to assist.
- -Document calls in appropriate tracking systems, and handle/escalate calls per established procedures.
- - Conduct insurance verifications to understand if patient’s prescribed therapy is eligible for coverage. Possibly coordinate prior authorizations, investigate alternative insurance coverage, or other funding sources on behalf of the patients per the program specifications.
- -Process patient applications of various complexities, and follow the programs specifications to determine their eligibility. Place follow up calls and respond to enquiries from patients and/or healthcare providers as necessary.
- -Liaise with partner distributors and pharmaceutical manufacturers to request products per the program’s guidelines and track shipments.
- -Coordinate the order and transfer of prescriptions based on their degrees of urgency to specialty pharmacies as appropriate.
- -Be familiar with the market place and the insurance options available for patients. Educate patients on the available options as appropriate.
- -Assist with training new team members by shadowing/reverse shadowing them and serving as a data checker by reviewing data entered in the program’s tracking system.
- -Maintain a professional, calm and friendly demeanor. Express thoughts and instructions clearly in both verbal and written communication; i.e. uses grammatically correct and concise language.
