Pharmacy Intake Coordinator

4 days ago

Orange, California, United States Specialty Care Rx Full time
Job Summary

Specialty Care Rx is seeking a highly skilled Pharmacy Intake Coordinator to join our team. As a Pharmacy Intake Coordinator, you will be responsible for communicating with patients to obtain information required to process prescriptions, refills, and access benefits. You will also investigate and verify insurance benefits and eligibility for pharmacy and medical third-party claims, obtain prior authorizations, and facilitate appeals processes.

Key Responsibilities
  • Communicate with patients to obtain information required to process prescriptions, refills, and access benefits.
  • Investigate and verify insurance benefits and eligibility for pharmacy and medical third-party claims.
  • Obtain prior authorizations and initiate requests, track progress, and expedite responses from insurance carriers and other payers.
  • Review prescribed treatment regimens for accuracy prior to submission of authorization.
  • Facilitate appeals processes between patients, physicians, and insurance companies.
  • Complete status checks with insurance companies regarding receipt and outcome of prior authorizations and appeals.
  • Track, report, and escalate service issues arising from requests for authorizations, financial assistance, or other issues that delay service.
  • Notify patients when their prescriptions have been transferred and follow up with specialty pharmacies to confirm receipt.
  • Coordinate verbal transfers by pharmacists if specialty pharmacies have no record of the prescription.
  • Complete assessments mandated by manufacturer contracts or operations and facilitate patient enrollment with manufacturer hubs.
  • Document case activity, communications, and correspondence in computer systems to ensure completeness and accuracy of patient contact records.
  • Ensure work activities are conducted in compliance with regulatory requirements and organizational standards and procedures.
  • Perform or assist with operations as required to maintain workflow and meet business needs.
Requirements
  • High School Diploma or GED.
  • Able to read medical charts.
  • 1 year of proven work experience in a healthcare setting.
  • Previous intake experience preferred but not required.
  • Superior telephone customer service skills.
  • Healthcare experience with a basic understanding of clinical terms and benefits investigation preferred.
  • Previous experience in a call center preferred where there is familiarity with metrics and a high level of accuracy and touches.
  • Strong organization skills and attention to detail.
  • Excellent knowledge of insurance benefit investigation process and techniques.
  • Demonstrated ability to manage a range of priorities and meet time commitments.
  • Excellent data management software skills with demonstrated adaptability to internal systems.
  • Demonstrated strength in listening, oral and written communications in English.
  • Pharmacy Technician Certification preferred but not required.
  • Any additional training in pharmacy/medical benefit access and requirements, preferred but not required.
  • CareTend experience preferred, but not required.

Physical Requirements

Employees in this role must meet certain physical demands to perform the essential functions effectively. Reasonable accommodations will be provided for individuals with disabilities to ensure they can perform these functions. This position involves frequent sitting and requires the ability to communicate effectively through talking and listening. Occasionally, the role requires standing, walking, and using hands to operate objects, tools, or controls. The employee may also need to reach with arms and engage in physical activities such as bending, kneeling, or crouching. Regularly, the employee must lift and move items weighing up to 20 pounds, with occasional lifting of items up to 50 pounds. Visual requirements include the ability to focus, as well as maintain peripheral vision and depth perception.

EEO Statement

We are committed to fostering a diverse and inclusive workplace. As an Equal Employment Opportunity (EEO) employer, we ensure that all employment decisions are based on merit, qualifications, and business needs. We do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other legally protected status. We provide a work environment free from discrimination and harassment, and we celebrate diversity by creating an inclusive environment for all employees.

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