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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).
Job Responsibility:
Initiate, research, complete, submit, and track Patient Services Program applications for assigned facilities
Conduct benefit verification and complete necessary third-party prior authorizations, reimbursement activities, patient assistance, and copay program enrollments
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
Proactively interact with facility staff, patients, payers, and patient assistance programs (PAP)
May need to adjust work schedule to support customers in different time zones
Provide services for a health system’s ambulatory pharmacy, specialty pharmacy and/or outpatient infusion center environment
Interact with patients and providers to obtain insurance benefits and patient information needed to request prior authorizations
Ensure patient-specific reimbursement related information is obtained and available for review and for tracking of replacement product
Obtain appropriate signatures and documentation for completed PAP applications
Complete patient adherence activities
Work within health system’s electronic medical record system and other applicable systems
Provide integrated services to the health system to increase prescription capture rate, ensure timely delivery of infusion medications, improve patient outcomes and reduce readmissions
Resolve barriers proactively that may affect reimbursement
Establish business relationships with assigned clinic staff, pharmacy, and hospital contacts
Assist on special projects within job scope to improve reimbursement optimization
Communicate patient and provider feedback to PHS management
Interface appropriately with assigned key account associates
Demonstrate flexibility and adapt to changes in payer, pharmacy and patient assistance program processes
Provide temporary coverage to support clients and patients
Requirements:
CPhT required
Florida Pharmacy Technician License preferred
2+ years of directly related or relevant experience
Broad training in fields such as 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
Bachelor's degree program preferred
Nice to have:
Florida Pharmacy Technician License
Bachelor's degree
What we offer:
Medical
dental
vision care
comprehensive suite of benefits focusing on physical, emotional, financial, and social aspects of wellness
Support for working families which may include backup dependent care, adoption assistance, infertility coverage, family building support, behavioral health solutions, paid parental leave, and paid caregiver leave
Training programs
Professional development resources
Opportunities to participate in mentorship programs, employee resource groups, volunteer activities