JOB RESPONSIBILITIES
- Process PAP applications electronically, utilizing the pharmacy CRM software systems and secure designated email accounts.
- Process fax queues, emails, answer incoming calls and adhere to all thresholds for PAP case review and management.
- Maintain clear communication and documentation with provider offices, patients and pharmacy account managers.
- Work closely with provider office point of contact(s) to obtain updated information in order to obtain missing supporting documents that are required for PAP eligibility.
- Input accurate and clear data entry of call logs, important case notes and authorization details into CRM system.
- Verify the accuracy and quality of data entry within PAP case documentation.
- Ability to confirm whether a therapy is complete and if a PAP renewal is needed.
- Initiate and follow-up on PAP renewal requests as assigned.
- Create and complete PAP data reports as assigned by the reimbursement director.
- Cross trained in the area of Rx Prior authorizations and Rx Appeal workflows to assist fellow reimbursement team members as needed.
- Contact patient’s insurance company to verify coverage, initiate authorizations, provide clinical documentation and follow up on previously submitted authorizations.
- To safeguard, protect and always demonstrate proper handling of protected health information in accordance with all HIPAA laws and ProCare Rx policies/procedures.
- Assess, prioritize and resolve client issues using good listening and comprehension skills.
- Works cooperatively and provides coverage for responsibilities of co-workers when assigned or as the need arises.
- Assist the reimbursement director with supervising and on-going training of new and/or existing PAP coordinators.
- Demonstrate working knowledge of all facets of the role, relevant regulations & organizational and departmental policies & procedures.
- Escalate issues to management as appropriate.
- Perform other duties as assigned to support ProCare Rx / ProMod Rx.
QUALIFICATIONS AND REQUIREMENTS
Previous Experience:
- Strong understanding of medical terminology, insurance plans and authorization processes.
- Bilingual English/Spanish is a plus.
- Minimum 3 years of pharmacy or healthcare experience required.
- Minimum 1 year management experience of a team of 5 or more employees, preferred not required.
- Working in a fast-paced environment for 3+ years is required.
- Ability to manage cases from multiple clientele programs and follow program business rules.
- Proficiency with data entry functions and Microsoft applications required.
- Ability to work independently and on a team.
- Excellent communication, problem solving and customer service skills.
- Strong organizational /interpersonal skills; attention to detail and the ability to multitask proficiently.
- Ability to use multiple PC monitors and navigate through several software systems effectively.
Education:
- High School Graduate required, College degree preferred.
- State Pharmacy Technician registration or PTCB National Certification preferred.
Physical Demands:
- Requires sitting, standing, and occasional light lifting.
The Perks of Joining Our Team:
We believe in taking care of our team. You'll enjoy a comprehensive benefits package designed to support your well-being and financial future:
- Comprehensive Health Benefits: Medical, Dental, Vision, Short-Term/Long-Term Disability Insurance, Life insurance.
- Time to Recharge: Paid vacation and holiday pay.
- Focus on Your Wellness: We offer a robust Employee Wellness Program.
- Invest in Your Future: 401 k with a company match.
- Support System: Employee Assistance Program provides confidential support and counseling.
- Get Rewarded for Referring Great People: Employee referral program.
ProCare Rx will never ask for a financial commitment from an applicant, as part of our recruitment process. All interviews are conducted in-person OR through video conference invitations from official company emails. For inquiries, please contact our official recruitment team at HR@procarerx.com
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ProCare Rx is an Equal Opportunity Employer.