Patient Access Specialist

McKesson•Cary, NC

28d•Hybrid

About The Position

The Patient Access Specialist, Rare/Orphan will be responsible for benefits investigation, prior authorization support, and claims adjudication, as well as refill management and delivery coordination functions in accordance with company policies and procedures. This is a hybrid role and will require two days a week in office at our Cary, NC location.

Requirements

Typically requires 1+ years of related experience.
High school diploma required
1+ years prior experience working in a pharmacy or other health care setting required
Experience with insurance eligibility and prior authorization processes
Competent in basic computer skills and proficiency in Microsoft applications
Conscientious, detail oriented with the ability and desire to solve problems to help our patients
Flexible, adaptable, and the ability to effectively work in a team setting to accomplish a common goal
Highly motivated and committed to excellence with a positive attitude

Nice To Haves

CPhT (Certified Pharmacy Technician) preferred, not required. Must be current, without restrictions, and in good standing
Strong interpersonal and communication skills; able to engage empathetically with patients and caregivers.
Understanding of HIPAA, patient privacy, and compliance regulations.
Strong prioritization and time management skills
Proficiency in quickly and thoroughly understanding patient and provider needs
Demonstrated ability to communicate complex concepts with high efficacy

Responsibilities

Locate and enter accurate prescription insurance information on patient’s profile by processing eligibility checks and adjudicating pharmacy claims.
Adjudicate claims and troubleshoot rejections so that the correct information is communicated to the patient
Communicate the need for medication prior authorization (PA) to providers and serve as a resource to the provider during the PA process.
Manage inbound calls from patients, clients, physicians, practitioners and clinics regarding inquiries about order status, services provided, financial support options
Serve as a technical resource pertaining to adjudication while identifying areas for improvement.
Entering detailed, accurate, and grammatically correct progress notes to ensure proper documentation on patient profiles.
Contact patients to schedule medication delivery and payment so that accurate information is included in their profile and distribution can successfully send their package in a timely manner
Manage patient refill coordination and follow-up to ensure patients comply with their therapy plan
Identify and report adverse events (AEs) and product complaints (PCs) to clinicians to ensure patient’s safety
Perform other duties as assigned (above tasks may vary slightly depending on the specific team/program requirements.)