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Pharmacy Claims Specialist

2 months ago

Irvine, California, United States Jobot Full time
Pharmacy Intake Representative

This position is hosted by Jobot.

About the Company:

Our client is a prominent provider in infusion therapy services, offering specialized care administered by trained infusion nurses. These services are available at various locations, including standalone facilities, physician offices, or patients' homes, ensuring personalized treatment for procedures such as IVIG, Hemophilia, Chemotherapy, TPN, and Pain Management.

Benefits of Working Here:
  • Competitive salary structure
  • Opportunities for bonus compensation
  • 401k plan with employer matching
  • Comprehensive medical insurance fully covered by the employer
  • Life and disability insurance coverage
  • Paid time off and holiday schedule


Key Responsibilities:
  • Engage with patients to gather necessary information for processing prescriptions, refills, and benefits access, while fostering long-term customer relationships.
  • Investigate and confirm benefits for pharmacy and medical claims for assigned cases, collaborating with financial assistance teams when necessary.
  • Manage prior authorization requests, ensuring all required information is submitted and tracking progress with insurance carriers.
  • Facilitate the appeals process by coordinating between patients, physicians, and insurance companies, including composing clinical appeal letters.
  • Ensure all clinical documentation is collected prior to submission of appeals and coordinate necessary appointments.
  • Conduct follow-ups with insurance companies regarding prior authorization and appeal statuses, activating copay cards as needed.
  • Monitor and escalate service issues related to authorizations and financial assistance to maintain patient access to necessary therapies.
  • Complete assessments required by manufacturer contracts and assist with patient enrollment in manufacturer programs.
  • Provide information to patients regarding financial assistance options and community resources.
  • Submit electronic applications for financial assistance on behalf of patients, ensuring timely filing to prevent therapy interruptions.
  • Follow up with assistance providers to track application statuses and advocate for patients as needed.
  • Document all case activities and communications in the system to maintain accurate patient records.
  • Adhere to regulatory requirements and organizational standards to ensure high-quality service delivery.


For more information, please refer to the application process.