Intake Representative (IVIG)

RE Pharmacy•Irvine, CA

4d•$28 - $32•Onsite

About The Position

River’s Edge Pharmacy has become a leader in infusion therapy services. Administered by specially trained infusion nurses, these services are provided at standalone locations, physicians’ offices. Each location provides individualized care in a private setting for procedures including IVIG, Hemophilia, Chemotherapy, TPN, and Pain Management. River’s Edge Pharmacy started in Rancho Mirage, CA in 2008 to address the need for compassionate care by specialty pharmacies. In 2013, the Company moved to a larger facility in Palm Desert, CA. The successful execution of River’s Edge Pharmacy’s growth strategy led to the opening of a total of nine infusion locations and two pharmacies in California. Since the expansion, River’s Edge Pharmacy has become the specialty pharmacy and infusion service provider of choice for patients and physicians seeking exceptional expertise, human kindness, and professional guidance. The team of pharmacists, technicians, and care experts at River’s Edge Pharmacy serve as patient advocates by combining professional expertise with caring support. These services are all part of River’s Edge Pharmacy’s commitment to helping patients live better lives while navigating the complicated world of medicine and health insurance.

Requirements

High school diploma or equivalent required
5 or more years prior Pharmacy or experience.
3 or more years prior experience with Specialty or Infusion Pharmacy medications.
Prior experience in processing Infusion therapy with strong emphasis on Ig therapy.
Thorough knowledge of Specialty Pharmacy laws and regulations.
Proficient with Microsoft Office Suite or related software.
Excellent verbal and written communication skills.
Excellent interpersonal, negotiation, and conflict resolution skills.
Excellent organizational skills and attention to detail.
Strong analytical and problem-solving skills.
Ability to prioritize tasks and to delegate them when appropriate.
Ability to act with integrity, professionalism, and confidentiality.

Nice To Haves

Associate or Bachelor’s degree in healthcare, life sciences, or business preferred
CA BOP Pharmacy Technician License preferred

Responsibilities

Communicate with patients to obtain information required to process prescriptions, refills, access benefits and apply charges against co-pay cards, and build trusted and enduring customer relationships that yield loyalty.
Investigate and verify benefits for pharmacy and medical third party claims for assigned cases. May communicate with financial assistance team of drug manufacturers to apply for and secure financial assistance for patient when assigned.
Obtain prior authorizations; initiate requests, follow up to provide additionally required information, track progress, and expedite responses from insurance carriers and other payers, and maintain contact with customers to keep them continuously informed. Review for accuracy of prescribed treatment regimen prior to submission of authorization.
Facilitate appeals process between the patient, physician and insurance company by requesting denial information and facilitates obtaining the denial letter from the insurance, patient or physician. Composes clinical appeals letters based off of specific denial reason and patients clinical presentation. Ensures all clinical information and documentation are obtained prior to appeal submission. Coordinates appointment of representative document with patient and physician office.
Completes status check with insurance company regarding receipt of prior authorization and appeal and approval or denial status. Obtains approval information and activates copay cards based off of eligibility and specific drug prescribed.
Track, report and escalate service issues arising from requests for authorizations, financial assistance or other issues that delay service, to ensure patient access and to avoid delays that may interrupt therapy.
Build and maintain effective business relationships with prescribers treating assigned set of disease states and provide ongoing communication of specific case-related information as appropriate.
Completes a series of assessments mandated by either manufacturer contracts or operations and facilitates patient enrollment with manufacturer Hubs when required.
Receive notification of patients in need of financial assistance to cover the cost of their prescriptions. Communicate with patients to provide information regarding assistance programs and community resources that provide the required assistance.
Obtain required information and permission from patients and submit electronic applications for financial assistance of their behalf, or provide patients with forms required by assistance providers, follow up to offer assistance to complete documents properly, and ensure that applications are filed in keeping with defined time limits to avoid interruption in therapy.
Follow up with assistance providers to determine the status of applications, expedite consideration of requests, advocate on behalf of patients, and track the status of applications and related activity.
Document case activity, communications and correspondence in computer system to ensure completeness and accuracy of patient contact records. Ensure that work activities are conducted in compliance with regulatory requirements and the organization’s defined standards and procedures, and in a manner that provides the best available level of service and quality.
Accurate and timely processing of new specialty pharmacy referrals with a strong emphasis on IVIG (Intravenous Immunoglobulin) therapies.
May perform other duties as assigned.