Under the general supervision of the Operations Manager, serves as a liaison between manufacturer representatives and/or specialty pharmacy contacts in order to effectively monitor patient status, triage and dispense data to prevent potential interruptions in patients' therapy and resolve errors in data reporting. Proactively monitors program reports to assess specialty pharmacy adherence to business requirements. PRIMARY DUTIES AND RESPONSIBILITIES:
Qualifications: EXPERIENCE AND EDUCATIONAL REQUIREMENTS:
- Lead and facilitate daily conference calls with specialty pharmacy contacts (and client, if applicable) to monitor patient progress, reconcile data discrepancies, research missing data, handle inquiries and provide updates as requested.
- Coordinate and process copay requests including but not limited to patient status requests, copay assistance, prior authorization and billing inquiries and obstacles, eligibility inquiries, and claims processing challenges.
- Create and maintain action log, agendas and minutes for each specialty pharmacy meeting.
- Handle inbound/outbound calls from all applicable customers including but not limited to specialty pharmacy contacts, client contacts, third party vendors and internal team resources.
- Triage and/or approve referrals to specialty pharmacies daily or as needed.
- Reference and implement Business Requirements Document (BRD) as it pertains to operating procedures, validation of incoming data from the Specialty Pharmacy, and identifying and escalating data feed issues internally and externally.
- Identify needed system enhancements and/or reports and participate in requirement review, testing and implementation.
- Implement business requirements for newly-contracted specialty pharmacies joining the network to ensure adherence to all contractual obligations; ensure all data is validated prior to program launch.
- Coordinate data transfer with client and ensure data integration during transition of product support services from another HUB provider.
- Share best practices and learning opportunities with reimbursement team
- Identify and report Adverse Events
Requires broad training in fields such as business administration, accounting, computer sciences, medical billing and coding, or similar vocations generally obtained through completion of a two year associate's degree program, technical vocational training, or equivalent combination of experience and education. Two or more (2 ) years directly related and progressively responsible reimbursement experience preferred. Preference given to candidates with a healthcare background (medical insurance, physician's office, pharmacy, hospital, etc.)MINIMUM SKILLS, KNOWLEDGE AND ABILITY REQUIREMENTS:
- Ability to communicate effectively both orally and in writing.
- Strong interpersonal skills.
- Strong negotiating skills.
- Strong mathematical skills.
- Strong organizational and time management skills; keen attention to detail.
- Ability to work independently, within a team environment.
- General knowledge of reimbursement principles, pharmacy operations and medical claims.
- General knowledge of HCPCS, CPT, ICD-9 and ICD-10 coding preferred.
- Global understanding of commercial and government payers preferred.
- Demonstrated proficiency with Microsoft Excel (intermediate level), Outlook and Word.
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