Intake Specialist

California Specialty Pharmacy,LLC•Birmingham, AL

75d

About The Position

Under direct and indirect supervision, the Intake Specialist is accountable for the management of the patient referral in a timely, seamless manner. The Intake Specialist is responsible for accurate qualification of patient insurance benefits and criteria. This is inclusive of referral source communications to ensure complete clinical information is received, direct payor communications to determine coverage, secure necessary authorizations, and direct patient communications to relay benefit coverage and financial liability.

Requirements

Completion of a Pharmacy Technician training program/certification; preferred but not required
Meet the Pharmacy Technician requirements of the respective state; preferred but not required
Strong computer skills (Microsoft Word, Excel, PowerPoint)
Exceptional communication - verbal and written
Exceptional interpersonal skills
Exceptional organizational and process skills
Ability to work well under pressure, meet timelines, and completes assigned projects.
Exceptional critical thinking and problem solving skills
Proven performance, history in related field
Exceptional attention to detail and demonstrated results
Exceptional track record of customer satisfaction

Nice To Haves

Have a minimum of 6 months Pharmacy Technician or related experience; have a good working knowledge of pharmacy procedures.
Working knowledge of Home Infusion, Specialty Infusion, and Durable Medical Equipment (DME)
4+ years of computer data entry experience or related field

Responsibilities

Verifies insurance benefits for commercial and governmental payors.
Gather and document a detailed comprehensive understanding of the various insurance plans and benefits for the different payors and effectively communicate the prescribed therapy and coverage requirements to the referral source, patient, and payor sources.
Obtains insurance authorizations in compliance with governmental and commercial payor requirements to ensure reimbursement of services provided to patients.
Obtains insurance authorizations as necessary in a timely manner.
Initiates a Letter of Agreement (LOA) as necessary.
Communicates well with internal and external customers in order to efficiently bring a patient from a referral to start of care.
Monitors incoming fax queue and enters new patient information into EMR.
Processes initial drug orders in EMR as prescribed for the patient and creates delivery ticket.
Prepares patient start of care packet for delivery.
Enters medication profile at start of care into EMR.
Demonstrates proficiency with EMR applications utilized by the company.
Communicates professionally to articulate benefit information, financial needs, and/or challenges to patients, referral sources, insurance carrier representatives, and internal teams in order to facilitate the referral process and obtain required information to initiate a patient's start of care.
Ensures timely follow-up and accurate documentation for start of care paperwork.
Demonstrates the ability to clearly, accurately, and concisely document progress notes in EMR.
Understands and provides exceptional customer service.
Availability for assisting with On-Call responsibilities, as needed. ("Taking Call/Being On-Call")
Performs all other duties assigned.