Pharmacy Intake Representative

Our client has become a leader in infusion therapy services. Administered by specially trained infusion nurses, these services are provided at standalone locations, physicians’ offices, or in the home of the patient. Each location provides individualized care in a private setting for procedures including IVIG, Hemophilia, Chemotherapy, TPN, and Pain Management.

KEY RESPONSIBILITIES:

• Communicate with patients to obtain information required to process prescriptions, refills, access benefits and apply charges against co-pay cards, and build trusted and enduring customer relationships that yield loyalty.
• Investigate and verify benefits for pharmacy and medical third-party claims for assigned cases. May communicate with the financial assistance team of drug manufacturers to apply for and secure financial assistance for patients when assigned.
• Obtain prior authorizations; initiate requests, follow up to provide the additional required information, track progress, 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 the appeals process between the patient, physician, and insurance company by requesting denial information and facilitating obtaining the denial letter from the insurance, patient, or physician. Composes clinical appeals letters based on specific denial reasons and patients’ clinical presentations. Ensures all clinical information and documentation are obtained prior to appeal submission. Coordinates appointment of representative documents with patient and physician office.
• Completes status checks with the insurance company regarding receipt of prior authorization and appeal and approval or denial status. Obtains approval information and activates 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, to ensure patient access and to avoid delays that may interrupt therapy.
• Build and maintain effective business relationships with prescribers treating assigned sets of disease states and provide ongoing communication of specific case-related information as appropriate.
• Completes a series of assessments mandated by either manufacturer contracts or operations and facilitates patient enrollment with manufacturer

Requirements:

• Previous experience as an Intake Representative in a retail setting.
• Pharmacy technician experience (Preferred)
• Excellent organizational skills and attention to detail.
• Proficient with Microsoft Office Suite or related software.