Our team members are at the heart of everything we do. At Cencora, we are united in our responsibility to create healthier futures, and every person here is essential to us being able to deliver on that purpose. If you want to make a difference at the center of health, come join our innovative company and help us improve the lives of people and animals everywhere. Apply today!
The Patient Services Specialist 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. This role requires proactive interaction with facility staff, patients, payers, and patient assistance programs (PAP). Occasional travel may be required. Rheumatology and EPIC experience required.
Location: Remote, USA
Hours: Monday to Friday 8a-4:30p CST
Responsbilities:
Performs patient onboarding, benefit verification, prior authorization, and appeals processes, as needed, on behalf of patients and their physician to facilitate the process between the doctors’ office and pharmacy to triage and streamline prescription fulfillment.
Provides above services for a health system’s ambulatory pharmacy, specialty pharmacy and/or outpatient infusion center environment, as requested.
Interacts with patients and providers to obtain insurance benefits and patient information needed to request prior authorizations so that medications and other services rendered are reimbursed by payer.
Ensures that patient-specific reimbursement related information is obtained and available for review and for tracking of replacement product, including maintenance of files and documentation for PAP application submissions.
Obtains appropriate signatures and documentation for completed PAP applications prior to submission of the application to the respective PAP.
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 (i.e., IndiCare™) to support workflow management and to document activities (i.e., retrieve information needed to deliver services, communicate status, and document outcome).
Provides integrated services to the health system and its component parts to increase prescription capture rate, improve patient outcomes and reduce readmissions.
Resolves barriers proactively that may affect reimbursement at assigned facilities and provides detailed updates to the Patient Assistance Services Management when unable to resolve independently.
Establish business relationships with assigned clinic staff, pharmacy, and hospital contacts, keeping them informed of significant changes in site-specific recovery potential based on changes to PAPs.
Readily assists on special projects within job scope to improve reimbursement optimization when requested by management.
Communicates patient and provider feedback to PHS management to enhance process improvement to enhance continuity of care.
Interfaces appropriately with assigned key account associates with information relevant to additional products and services provided by Cencora and its subsidiaries.
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.
Performs related duties as assigned.
Education:
This position requires 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. Pharmacy Technician Certification Board (PTCB) or Certified Medical Assistant (CMA) or state certification may be required, contingent on client requirements.
Skills:
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
What Cencora offers
We provide compensation, benefits, and resources that enable a highly inclusive culture and support our team members’ ability to live with purpose every day. In addition to traditional offerings like medical, dental, and vision care, we also provide a comprehensive suite of benefits that focus on the physical, emotional, financial, and social aspects of wellness. This encompasses 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. To encourage your personal growth, we also offer a variety of training programs, professional development resources, and opportunities to participate in mentorship programs, employee resource groups, volunteer activities, and much more. For details, visit https://www.virtualfairhub.com/cencora
$42,600 - 60,940
*This Salary Range reflects a National Average for this job. The actual range may vary based on your locale. Ranges in Colorado/California/Washington/New York/Hawaii/Vermont/Minnesota/Massachusetts/Illinois State-specific locations may be up to 10% lower than the minimum salary range, and 12% higher than the maximum salary range.
Equal Employment Opportunity
Cencora is committed to providing equal employment opportunity without regard to race, color, religion, sex, sexual orientation, gender identity, genetic information, national origin, age, disability, veteran status or membership in any other class protected by federal, state or local law.
The company’s continued success depends on the full and effective utilization of qualified individuals. Therefore, harassment is prohibited and all matters related to recruiting, training, compensation, benefits, promotions and transfers comply with equal opportunity principles and are non-discriminatory.
Cencora is committed to providing reasonable accommodations to individuals with disabilities during the employment process which are consistent with legal requirements. If you wish to request an accommodation while seeking employment, please call 888.692.2272 or email hrsc@cencora.com. We will make accommodation determinations on a request-by-request basis. Messages and emails regarding anything other than accommodations requests will not be returned
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Affiliated Companies:
Affiliated Companies: AmerisourceBergen Drug Corporation
