Patient Benefit Representative

Position Title: Patient Benefit Representative/Patient Access Specialist

Work Location: Cary NC 27513

Assignment Duration: 3 Months

Work Schedule: Monday - Friday 9am - 6pm, 10am-7pm

Work Arrangement: Hybrid (in office twice a week - Monday and the team member can select the other day

Position Summary:

The Patient Access Specialist, Rare/Orphan will be responsible for benefits investigation, prior authorization support, and claims adjudication, as well as refill management and delivery coordination functions in accordance with company policies and procedures.

Background & Context:

At our organization, our mission is to simplify access to medication and deliver personalized care that helps patients achieve the best-possible outcomes - one patient, one partner, one therapy at time.

Key Responsibilities:

* Locate and enter accurate prescription insurance information on patient's profile by processing eligibility checks and adjudicating pharmacy claims.

* Adjudicate claims and troubleshoot rejections so that the correct information is communicated to the patient

* Communicate the need for medication prior authorization (PA) to providers and serve as a resource to the provider during the PA process.

* Manage inbound calls from patients, clients, physicians, practitioners and clinics regarding inquiries about order status, services provided, financial support options

* Serve as a technical resource pertaining to adjudication while identifying areas for improvement.

* Entering detailed, accurate, and grammatically correct progress notes to ensure proper documentation on patient profiles.

* Contact patients to schedule medication delivery and payment so that accurate information is included in their profile and distribution can successfully send their package in a timely manner

* Manage patient refill coordination and follow-up to ensure patients comply with their therapy plan

* Identify and report adverse events (AEs) and product complaints (PCs) to clinicians to ensure patient's safety

* Perform other duties as assigned (above tasks may vary slightly depending on the specific team/program requirements.)

Qualification & Experience:

* CPhT (Certified Pharmacy Technician) preferred, not required. Must be current, without restrictions, and in good standing

* High school diploma required

* 2+ years prior experience working in a pharmacy or other health care setting required

* Experience with insurance eligibility and prior authorization processes

* Competent in basic computer skills and proficiency in Microsoft applications

* Conscientious, detail oriented with the ability and desire to solve problems to help our patients

* Flexible, adaptable, and the ability to effectively work in a team setting to accomplish a common goal

* Highly motivated and committed to excellence with a positive attitude

* Strong interpersonal and communication skills; able to engage empathetically with patients and caregivers.

* Understanding of HIPAA, patient privacy, and compliance regulations.

* Strong prioritization and time management skills

* Proficiency in quickly and thoroughly understanding patient and provider needs

* Demonstrated ability to communicate complex concepts with high efficacy