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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). May need to adjust work schedule to support customers in different time zones. May need to work on Cencora Holidays. Occasional travel may be required.
Interacts 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
Obtains appropriate signatures and documentation for completed PAP applications prior to submission
Completes patient adherence activities that may include notification of upcoming refills, coordination, tracking, and confirmation of prescription delivery
Works within health system’s electronic medical record system and other applicable systems to support workflow management and to document activities
Provides integrated services to the health system and its component parts to increase prescription capture rate, ensure timely delivery of infusion medications, improve patient outcomes and reduce readmissions
Resolves barriers proactively that may affect reimbursement at assigned facilities
Establish business relationships with assigned clinic staff, pharmacy, and hospital contacts
Readily assists on special projects within job scope to improve reimbursement optimization
Communicates patient and provider feedback to PHS management to enhance process improvement
Interfaces appropriately with assigned key account associates with information relevant to additional products and services
Demonstrates flexibility and adapts to changes in payer, pharmacy and patient assistance program processes and requirements
Provides temporary coverage to support clients and patients in the event of onsite resource absences
Requirements:
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
2+ years of directly related or relevant experience
CPhT required
Florida Pharmacy Technician License preferred
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
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:
Florida Pharmacy Technician License
Bachelor's degree
What we offer:
Medical
dental
vision care
comprehensive suite of benefits that focus on the 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
variety of training programs
professional development resources
opportunities to participate in mentorship programs, employee resource groups, volunteer activities