Pharmacy Intake Coordinator

Description

Roles and Responsibilities

• Communicate with patients to obtain information required to process prescriptions, refills, access benefits and apply charges against co-pay cards.
• Investigate and verify insurance benefits and eligibility for pharmacy and medical third-party claims for assigned cases.
• Obtain prior authorizations; initiate requests, track progress, and expedite responses from insurance carriers and other payers, and maintain contact with customers to keep them continuously informed.
• Review for accuracy of prescribed treatment regimen prior to submission of authorization.
• Facilitate appeals process between the patient, physician, and insurance company; compose clinical appeals letters based on specific denial reason and patients clinical presentation and coordinate appointment of representative document.
• Complete status check with insurance company regarding receipt / outcome of prior authorization and appeal; obtain approval information and activate copay cards based on eligibility and specific drug prescribed.
• Track, report and escalate service issues arising from requests for authorizations, financial assistance or other issues that delay service.
• Notify patients when their prescription has been transferred and follow up with specialty pharmacy to confirm the prescription was received (in some jurisdictions).
• Coordinate verbal transfer by a pharmacist if specialty pharmacy has no record of prescription (in some jurisdictions); confirm with patient that prescription was received from alternate specialty pharmacy.
• Complete a series of assessments mandated by either manufacturer contracts or operations and facilitate patient enrollment with manufacturer Hubs when required.
• Document case activity, communications, and correspondence in computer system to ensure completeness and accuracy of patient contact records.
• Ensure that work activities are conducted in compliance with regulatory requirements and the organization defined standards and procedures, and in a manner that provides the best available level of service and quality.
• Perform or assist with any operations, as required to maintain workflow and to meet business needs.
• Must be able to perform the essential job functions of this position with or without reasonable accommodation.
• Participate in any variety of meetings and work groups to integrate activities, communicate issues, obtain approvals, resolve problems, and maintain specified level of knowledge pertaining to

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