> Position: Patient Care Associate Location: Jeffersonville, IN
Job Id: 542 # of Openings: 0
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When you join the team as a Patient Care Associate (Case Manager/Benefit Specialist), you'll have the opportunity to make a difference in the lives of our patients each day as they look to you as part of their dedicated support team for helping them navigate the tricky process to getting access to their complex medication. You'll 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. You'll adjust your 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. This role may be eligible for a hybrid schedule after 6 months (or sooner once proficiency in role is demonstrated). Review our Benefits & Perks below to learn more!
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, PharmaCord Lynk) 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!
A typical day in the life of a Patient Care Associate, will include the following:
The responsibilities include, but are not limited to the following:
Relationship Management
Builds trusted relationships with patients, prescribers, client stakeholders through proactive communication, timely and accurate execution of deliverables and demonstrated relentless passion for helping patients
Manages all relationships in a manner that adheres to healthcare laws and regulations
Communications
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, as applicable, pursuant to business rules
Inbound Call Management
Manages inbound calls as directed by the program-approved FAQs
Triage patients to internal or external resources as appropriate
Personalized Case Management
Provides personalized case management to patients and HCPs including outbound communication to HCPs and patients to communicate benefit coverage and next steps in obtaining coverage
Leverages electronic tools to identify benefits and payer coverage; completes manual benefit investigation as needed
Identifies and communicates patient's plan benefit coverage including the need for prior authorization, appeal, tier exception, and/or formulary exclusions
Uses electronic resources to obtain benefit coverage outcome and if needed, outbound call to payers and HCPs to follow up on proper submission and/or outcome
Coordinates nurse teach with field-based nurse educators, as applicable to program
Supports adherence services through coordination of nurse follow up, as applicable to program
Identifies peer support resources for patients
Coordinates shipment of product through patient assistance program and/or bridge program from the PharmaCord pharmacy
Proactively communicates needs for reverification of prior authorization or re-enrollment for patient assistance program
Reports adverse events, Product complaints, special situation reports and/or medical inquiries received in accordance with SOPs and the Business Rules
Documents all activities within the PharmaCord Lynk system in accordance with business requirements
Benefit Verification:
Performing patient level benefits verifications as applicable for all major medical and 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.
Patient Assistance:
Review of patient assistance enrollment forms and any supporting documentation to assess patient eligibility for participation as per SOPs and program guidelines.
Determination of patient's eligibility based upon program criteria for qualification.
Communicating the patient's eligibility to the patient, healthcare provider, and/or consignment pharmacy.
Answer and assist inbound callers through resolution utilizing answers to frequently asked questions or by warm transferring callers to other appropriate individuals.
Actively listen to each customer, assess needs, and respond with demonstrated patience and courtesy.
Review and identification of 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.
Provides timely feedback to the company regarding service failures or customer concerns
Effectively uses our internal technology platform, Lynk, to complete claims processing and keep workflows moving.
Communicate with key medical practice accounts, sales representatives regarding the status of cases. Provide consultative services where issues arise on how obstacles can be overcome to get patient on paid therapy.
Expected to be patient focused and committed to providing the highest quality customer service all while maintaining a sense of compliance and commitment to abiding by company policies and procedures.
This job might be for you if (must have requirements of the role):
Successful candidates possess the following personal attributes:
Requirements:
Physical Demands & Work Environment:
Once you land this position, you'll get to enjoy:
Our Benefits & Perks
Company paid Short-term Disability (STD)
Increased competitive 401(k) company match up to 4%
Affordable Medical, Dental, and Vision benefits - PharmaCord covers 75% of Medical Premiums for our employees
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
Competitive Compensation & Flexible Working
A Career You'll Love
Any offer of employment is contingent on completion of a background check to company standard. Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
At PharmaCord, we don't just accept difference \u2013 we celebrate it, support it and we thrive on it for the benefit of our employees, our products and our community. PharmaCord is proud to be an equal opportunity employer.
PharmaCord is unable to sponsor employees at this time.
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