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Case Managers

Ascent Portland Contractor
$19.00 - $31.00 / hour
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What we are looking for:
  • We are huge on PERSONALITY. We want people on their team that are passionate about HELPING OTHERS.
  • We are seeking candidates who are adaptable and EAGER TO LEARN!
  • Quote from managers: “Personality and adaptability is what we look for.”
About Access Solutions
  • Access Solutions is committed to helping patients access the medicines they need. Over the past 20+ years, our client has helped more than. 1.5 million. patients access the medicines they need.
Case Manager -
Responsibilities
The Customer Service liaison between patients, providers, MDs, pharmacies and insurance carrier to assure services are provided in the least restrictive, least costly manner.
  • Provide customer focused reimbursement support to patients, pharmacists, physicians, and internal sales force.
  • Educate, inform, and assist patients (and their families) and providers to navigate through the reimbursement and appeal process for the assigned product.
  • Identify barriers to reimbursement and continually identify and recommend program efficiencies to the Supervisor to promote a high quality of work.
  • Identify and facilitate referrals to alternative coverage options and financial assistance programs for patients who are under insured or require copy assistance.
  • Establish relationships with appropriate stakeholders including internal & external partners.
  • Conduct benefits coverage and payer research/investigations to ensure appropriate resources, compliance with payer appeal policies, practices, and timelines.
Qualifications:
  • Bachelor's degree is preferred.
  • Demonstrates effective problem-solving skills and provides excellent customer service.
  • Excellent investigational and analytical skills with a proven ability to communicate effectively in both written and verbal format.
  • Ability to work collaboratively in a team structure and responsibly delegate next steps to appropriate team members.
  • Able to work effectively under pressure and prioritize tasks.
  • Able to follow written Standard Operating Procedure.
Preferred Experience:
  • Reimbursement experience preferred.
  • Knowledge of the managed care industry, including government payers.
  • Proficient in all aspects of reimbursement (i.e., benefit investigations, payer reimbursement policies, regulatory and administrative rules).
  • Understands reimbursement/funding resources and how to access these resources.
Foundation Specialist -
Purpose: The Foundation Specialist evaluates patient eligibility for Access to Care Foundation and coordinates shipments of products to patients within program guidelines.

Responsibilities:
  • Provides customer focused support to patients and providers.
  • Works collaboratively with peers to move casework forward.
  • Assists patients and providers in enrollment process for assigned products.
  • Evaluates patient eligibility across key criteria and communicates determinations.
  • Coordinates delivery of product following all shipping policies and procedures.
  • Actively supports product launches, line extensions and formulation changes.
  • Embeds a culture of compliance by ensuring self, colleagues and team members are adhering to laws, regulations, and policies that govern Foundation conduct.
Experience:
  • Bachelor's degree is preferred or equivalent experience.
  • A minimum of 3 years reimbursement experience is preferred.
  • Knowledge of the managed care industry, including government payers.
  • Proficient in all aspects of reimbursement (i.e., benefit investigations, payer reimbursement policies, regulatory and administrative rules).
  • Understands reimbursement/funding resources and how to access these resources.
  • Excellent investigational and analytical skills with a proven ability to communicate effectively in both written and verbal format.
  • Ability to work collaboratively in a team structure and responsibly delegate next steps to appropriate team members.
  • Demonstrates effective problem solving and excellent customer service.
  • Exceptional attention to detail.
  • Able to work effectively under pressure and prioritize tasks.
  • Able to follow written Standard Operating Procedure.
Patient Resource Specialist -
Purpose:  The Patient Resource Specialist (PRS) is a team member of the Patient Resource Center (PRC) which is one of the first points of contact for most of the business, clinical, and non-clinical calls.
 
Key Responsibilities: 
  • Analyze the most effective next step in successfully resolving calls, using a large breadth of processes and procedures, while utilizing access to multiple systems and databases.
    Provide customer contact for inquiries via phone or email, as well as hard copy mailed communications coming in.
    Resolve all inquiries by assisting, escalating or locating an appropriate resource, and do so within one business day of when the inquiry is received. 
  • Answer multiple customer facing phone lines.
  • Receive calls via internal company transfers from multiple sources.
  • Document all external and internal interactions in the SFDC-Case Management system. 
  • Provide technical phone support for My Patient Solutions (online portal for MD Offices to submit and follow up on patient referrals). The PRS provides MPS tech support to MD offices that utilize MPS, as well as to Field Reimbursement Managers, Case Managers, and Foundation Specialists.
Skills and Experiences:
  • Bachelor's degree is preferred.
  • 4 years of previous customer service experience and advance call handling.
  • Health Care related customer service experience a plus.
  • Ability to communicate clearly with technical and non-technical audiences, both verbally and written.
  • Familiarity with network/IT concepts, with experience in analyzing technical data, drawing appropriate conclusions, and if needed, recommending appropriate changes.
  • Outstanding customer service skills (including ability to handle high volume of escalated calls from various parts of the organization).
  • Attention to detail, strong multi-tasking ability, organizational skills, effective time management, and accuracy of data entry.
  • One to two years of IT tech support experience.
  • Strong independent decision-making and problem-solving skills utilized to find creative solutions to unexpected situations and problems. 
  • Proficiency, or ability to learn and utilize, various departmental computer applications including, but not limited to SFDC-Case Management, Epiphany, GOLF, Epsilon, IRT, SAP, MedWatch.
Reimbursement Specialist -
Key Responsibilities/Accountabilities: 
  • Investigate patient's insurance benefits.
  • Identify network providers, provider restrictions, and co-pays as needed.
  • Document requirements for prior authorization and medical review process.
  • Document activities appropriately in progress notes.
  • Pursue product coverage for patients in accordance with the payer's authorization requirements within the departments established performance criteria.
  • Maintain payer profiles by recording payer specific data promptly into the system.
  • Convey outcomes of benefit investigation to internal contacts (i.e. case managers).
  • Learn processes for multiple products and effectively apply learnings to provide effective reimbursement services.
  • Conduct all work in a compliant manner.
  • Consult with team members on an as needed basis.
Recommended Skills and Experiences:
  • Bachelor's degree is preferred or equivalent experience.
  • A minimum of 3 years reimbursement experience is preferred.
  • Knowledge of managed care industry including government payers.  
  • Proficient in all aspects of reimbursement (i.e., benefit investigations, payer reimbursement policies, regulatory and administrative rules).
  • Understands reimbursement/funding resources and how to access these resources.
  • Excellent investigational and analytical skills with a proven ability to communicate effectively in both written and verbal format.
  • Ability to work collaboratively in a team structure and responsibly delegate next steps to appropriate team members.
  • Demonstrates effective problem solving and excellent customer service.
  • Exceptional attention to detail and ability to prioritize tasks.
  • Must be able to follow written Standard Operating Procedure.
Periodic mandatory overtime throughout the year is required in Access Solutions Operations.  This may include, but is not limited to, high referral season (Blizzard, Enrollment renewal), new product or system launches, new line extensions, or any unexpected surge in volume or backlog situations. May include weekends as needed.
 

 

Skills required

Problem Solving
Program Management
Program Development
Determine Best Practices
Coordinating
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The Ascent Services Group (ASG) is a leading national technology consulting and professional services firm that focuses on tactical and strategic consulting. ASG’s fundamental business is providing staffing services to Large Enterprise clients in our core market verticals: Financial Services, Healthcare, and Life Sciences. We focus the majority of our efforts in Staff Augmentation support of Large Enterprise Clients who utilize a Vendor Management System. ASG works as both a reliable supplier in support of programs, as well as a Strategic Advisor in support of enterprise efforts to establish best in class preferred vendor programs. ASG was ranked in the 2007 and 2008 Inc. 500 and recognized specifically for its innovative work in staff augmentation support of Large Enterprise preferred vendor accounts.

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