Member of a dedicated support team for helping them navigate the tricky process to getting access to their complex medication
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 and efficient management of their records
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
A typical day in this role will include ownership of your patients cases from initiation to closure to include; benefit investigations, prior authorizations / denial appeals, determining financial qualifications for assistance programs and assisting patients or other callers/stakeholders through resolution (via email, inbound/outbound calls and using our patented technology) by using your critical thinking skills and your knowledge of the program and industry rules and standards
This role requires a high level of ownership, attention to detail and patient focus and will put your problem-solving skills to the test
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.
Performing patient level benefits verifications as applicable for all major medical pharmacy benefits plans
Completion of the template forms that provide patient level benefits Coverage Determination Summary
Coordination of prior authorizations based on payer guidelines and in compliance with law, regulation or guidance
Review of patient assistance enrollment forms and any supporting documentation to asses patient eligibility for participation as per SOP's and program guidelines
Determination of patients eligibility based upon program criteria for qualification
Communicating the patients eligibility to the patient, healthcare provider, and/or pharmacy
Performs program welcome calls to patients
Performs post Benefits Investigation calls to patients and physicians explaining coverage options
Manages all client inquiries unable to be determined by client through reporting
Manages HCP inquiries
Manages inbound calls as directed by the program-approved FAQ's (can be up to 50 calls per day during peak season)
Triage patients to internal or external resources as appropriate
Answer and assist inbound callers through resolution utilizing answers to frequently asked questions or by warm transferring callers to appropriate individuals
Review and identify information that is missing and/or incorrect within program service requests/program applications
Reporting of adverse events/product complaint inquiries received in accordance with SOP and good manufacturer practices
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
Required availability between 8:00 AM – 8:00 PM (8 hour shift between this time frame)
Call Center, healthcare, or prior authorization experience preferred
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.