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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 Us:

Our organization is recognized as a frontrunner in infusion therapy solutions. Our services, administered by specially trained infusion nurses, are offered at various locations, including standalone facilities, physician offices, or directly in patients' homes. Each site delivers personalized care in a confidential environment for treatments such as IVIG, Hemophilia, Chemotherapy, TPN, and Pain Management.

Benefits of Working With Us:
  • Competitive salary
  • Opportunities for bonus compensation
  • 401k plan with matching contributions
  • Comprehensive employer-paid health insurance
  • Life and disability coverage
  • Paid time off and holiday schedule


Key Responsibilities:
  • Engage with patients to gather necessary information for processing prescriptions, refills, benefit access, and managing co-pay cards, while fostering strong and lasting customer relationships.
  • Investigate and confirm benefits for pharmacy and medical claims related to assigned cases. May liaise with financial assistance teams from pharmaceutical manufacturers to secure financial support for patients as needed.
  • Initiate and manage prior authorization requests; follow up to provide additional required information, track progress, and expedite responses from insurance providers, while keeping customers informed throughout the process. Ensure accuracy of prescribed treatment regimens before submission.
  • Facilitate the appeals process between patients, physicians, and insurance companies by obtaining denial information and securing denial letters. Draft clinical appeal letters based on specific denial reasons and patient clinical presentations.
  • Ensure all clinical documentation is collected prior to submitting appeals. Coordinate with patients and physician offices regarding representative appointment documentation.
  • Conduct status checks with insurance companies regarding prior authorization and appeal submissions, obtaining approval information and activating co-pay cards based on eligibility and prescribed medications.
  • Monitor, report, and escalate service issues arising from authorization requests, financial assistance, or other matters that may delay service, ensuring patient access and continuity of therapy.
  • Complete assessments mandated by manufacturer contracts or operational requirements and assist with patient enrollment in manufacturer hubs when necessary.
  • Respond to notifications of patients requiring financial assistance for their prescriptions. Provide information on assistance programs and community resources available to support patients.
  • Collect necessary information and permissions from patients to submit electronic applications for financial assistance on their behalf, or guide patients in completing required forms, ensuring timely submission to prevent therapy interruptions.
  • Follow up with assistance providers to check application statuses, expedite requests, advocate for patients, and track application progress and related activities.
  • Document all case activities, communications, and correspondence in the computer system to maintain accurate patient contact records.
  • Ensure compliance with regulatory requirements and organizational standards in all work activities, delivering the highest level of service and quality.


Interested in learning more? Please apply through the appropriate channels.