Access & Support Specialist II

United Therapeutics Corporation•Melbourne, FL

3d•Onsite

About The Position

United Therapeutics (Nasdaq: UTHR) is a public benefit corporation dedicated to developing novel pharmaceutical therapies and technologies for rare, deadly diseases and to address the shortage of transplantable organs. The company has developed six FDA-approved therapies for conditions like pulmonary arterial hypertension (PAH), pulmonary hypertension associated with interstitial lung disease (PH-ILD), and neuroblastoma. United Therapeutics is also working on creating manufactured organs to eliminate transplant waiting lists. The Access & Support Specialist II role provides reimbursement support services to healthcare providers and patients, responding to requests for assistance, conducting eligibility reviews, and ensuring Patient Assistance Program participants meet ongoing requirements. This role involves explaining prior authorization, appeal, and denial issues, documenting calls, conducting benefits investigations, and communicating with various stakeholders. The specialist will utilize company software for patient assistance and reimbursement support, verify application completion, manage re-certification and other records, and ensure accurate reporting and compliance with company policies and procedures. They will also collaborate with team members and management, complete training, and mentor new team members as needed.

Requirements

H.S. Diploma or General Education Degree (GED)
2+ years of experience in a customer service/reimbursement support environment and/or in a healthcare/life sciences related field
Experience working with insurance providers
Demonstrated excellence in customer service
Proficient in reimbursement support and insurance coverage
Ability to review available coverage information
Able to effectively handle questions pertaining to prior authorizations, denials and appeals
Essential telephone and electronic communication skills
Demonstrated ability to work as a team member with a focus on exceeding customer/client expectations
Problem solving skills
Able to handle challenges in a professional manner
Self-motivated and able to demonstrate initiative to work independently
Strong interpersonal communication, time-management, organization and relationship building skills
Able to work a flexible schedule if necessary
Proficiency with MS Office Suite and internet applications
Candidates must be able to work from 10:00 a.m. to 7:00 p.m.

Nice To Haves

Associate Degree
Specialty Medication benefit knowledge

Responsibilities

Provide limited, approved, and otherwise publicly available information to explain prior authorization, appeal, and denial issues specific to different payors
Ensure all questions and calls are documented and responded to in a timely manner
Collect and conduct benefits investigation information in an efficient manner
Communicate with healthcare providers, insurance plans, patients, and their authorized representatives as needed. Triage inquiries appropriately and escalate issues per established escalation protocol
Effectively utilize UT software and tools for the coordination of the patient assistance program support, as well reimbursement support, and conduct assistance application completion verification
Execute required tasks to record re-certification and other additional records while patient is provided access. Collect, categorize, and store necessary records to prove eligibility for patient assistance program
Ensure accurate reporting of calls and activities to management. Ensure all department records are current, accurate, and well maintained
Ensure ASSIST operations follow established policies and procedures. Report any instances of misconduct or non-compliance with UT policies and procedures
Follow UT code of conduct, policies and procedures, standard operating procedures, and any other business rules applicable to ASSIST
Provide information and data to management in a timely and complete manner
Communicate and collaborate professionally with team members, Field Reimbursement Management Team, and clients
Complete assigned training and education requirements. Maintain expertise and up to date knowledge of UT patient access and UT copay programs policies, procedures, business rules, related operations, and insurance requirement for UT products
Complete special projects with limited oversight and supervision, and mentor new team members on an as needed basis