Patient Services Specialist

The Patient Services Specialist I is responsible for initiating, researching, completing, submitting, and tracking Patient Services Program applications for assigned facilities. The incumbent is responsible for conducting benefit verification and completing necessary third-party prior authorizations, reimbursement activities, patient assistance, and copay program enrollments. They may also coordinate refill calls, perform documented adherence activities, and coordinate dispensing for specialty medications, high-cost prescriptions, and/or infusion medications for both the pharmacy and medical benefit. This role requires proactive interaction with facility staff, patients, payers, and patient assistance programs (PAP). May need to adjust work schedule to support customers in different time zones.

Responsibilities

Performs patient onboarding, benefit verification, prior authorization, financial assistance and appeals processes on behalf of patients and their physician to facilitate the process between the doctors' office and pharmacy; Provides services for a health system's ambulatory pharmacy, specialty pharmacy and/or outpatient infusion center environment; Interacts with patients and providers to obtain insurance benefits and patient information needed to request prior authorizations; Ensures patient-specific reimbursement related information is obtained and available for review and tracking; Obtains appropriate signatures and documentation for completed PAP applications prior to submission; Completes patient adherence activities including notification of upcoming refills, coordination, tracking, and confirmation of prescription delivery; Works within health system's electronic medical record system and other applicable systems; Provides integrated services to increase prescription capture rate, ensure timely delivery of infusion medications, improve patient outcomes and reduce readmissions; Resolves barriers proactively affecting reimbursement and provides detailed updates to Patient Access Management team; Establishes business relationships with assigned clinic staff, pharmacy, and hospital contacts; Assists on special projects within job scope to improve reimbursement optimization; Communicates patient and provider feedback to PHS management; Interfaces appropriately with assigned key account associates; Demonstrates flexibility and adapts to changes in payer, pharmacy and patient assistance program processes; Provides temporary coverage to support clients and patients in the event of onsite resource absences; Performs related duties as assigned

Requirements

National CPhT certification; Pharmacy Technician Certification Board (PTCB) certification; broad training in Medical Office Administration, Social Work, Medical Records/Billing, Benefit Verification, Patient Financial Services, Pharmacy, Nursing, or similar vocations generally obtained through completion of a 2-year Associate Degree, technical vocational training, or equivalent combination of experience and education; 2+ years of directly related or relevant experience; ability to communicate effectively both orally and in writing; strong organizational skills; attention to detail; ability to work quickly and accurately under time and volume constraints; ability to be proactive and tenaciously seek solutions under minimum supervision to improve customer satisfaction; demonstrated competence in Microsoft Excel and Word; strong analytical skills; strong interpersonal skills; familiarity with insurance/claims processing, pharmaceutical products, services, software, and drug interactions

Nice to have

Bachelor's degree program preferred

Benefits

medical, dental, and vision care; comprehensive suite of benefits focusing on physical, emotional, financial, and social wellness; support for working families including backup dependent care, adoption assistance, infertility coverage, family building support; behavioral health solutions; paid parental leave; paid caregiver leave; training programs; professional development resources; mentorship programs; employee resource groups; volunteer activities