Patient Copay Support Representative

Omega•Boca Raton, FL

9h•Hybrid

About The Position

This role is responsible for providing support to patients regarding prescription costs and access programs. The Patient Copay Support Representative will handle inbound contacts, explain healthcare benefit concepts, screen patients for program eligibility, and assist with copay program inquiries. Additionally, the role involves verifying insurance benefits, resolving rejected pharmacy claims, and coordinating with various stakeholders to ensure issue resolution. Accurate documentation, adherence to compliance standards, and timely escalation of complex issues are critical components of this position.

Requirements

High School Diploma or GED required.
Working knowledge of U.S. healthcare insurance concepts, including copays, deductibles, coinsurance, and out-of-pocket maximums, along with general pharmacy and healthcare terminology.
Strong interpersonal, communication, and customer service skills, with the ability to remain calm and professional during sensitive or difficult interactions.
Comfort with technology and the ability to navigate multiple applications, databases, CRM tools, and dual monitors while maintaining an effective voice interaction.
Ability to multitask, follow established procedures, document accurately, protect confidential information, and escalate issues appropriately.
Ability and willingness to complete all required Omega, client, and program training, which may include emotional sensitivity, privacy, security, systems, and program-specific training.
Ability to communicate effectively with patients and healthcare professionals, including physicians, nurses, pharmacists, and pharmacy staff.

Nice To Haves

One to two years of experience in a pharmacy billing call center, retail pharmacy, medical front office, or healthcare-focused customer service environment.
Active state Pharmacy Technician registration/licensure and national certification such as CPhT/PTCB or equivalent.
Spanish/English bilingual capability.
Additional post-secondary education or healthcare-related training.

Responsibilities

Respond to a high volume of inbound contacts from patients, caregivers, providers, pharmacies, and advocates regarding prescription costs, pharmacy processing issues, available access programs, enrollment, and eligibility screening.
Explain common healthcare and pharmacy benefit concepts in plain language, including copays, deductibles, coinsurance, out-of-pocket maximums, coverage limitations, and accumulator/maximizer program impacts.
Screen patients for manufacturer copay card and financial assistance program eligibility using established criteria and support appropriate enrollment, activation, and referral workflows.
Assist with copay program questions, including enrollment status, card balance, annual limits, expiration, activation, and other program-related inquiries.
Provide empathetic, high-touch customer service and help patients understand next steps while maintaining appropriate professional boundaries.
Contact payers and/or pharmacy benefit managers, as applicable, to obtain and document benefit information, coverage details, and patient responsibility information, including participation in accumulator or maximizer programs.
Read and interpret explanation of benefits (EOB) information, prescription claim responses, patient responsibility amounts, insurance benefit information, and common pharmacy rejection messages within the scope of the assigned program.
Research and resolve common rejected pharmacy claims using established procedures, including eligibility issues, refill-too-soon rejections, coordination-of-benefits issues, prior authorization requirements, plan limitations, and other third-party billing rejections.
Coordinate with payers, pharmacy benefit managers, patients, pharmacies, providers, and internal teams to obtain information and move issues toward appropriate resolution.
Monitor and communicate the status of pending prior authorizations, identify outstanding requirements, and coordinate with the appropriate internal team, payer, pharmacy, or provider office.
Maintain accurate patient and insurance information, including policy identification numbers, group numbers, BIN information, contact details, and other required data elements.
Document patient interactions, benefit findings, claim activity, enrollment activity, commitments, and next steps accurately and chronologically in the designated CRM or case management system.
Verify patient identity and follow all applicable HIPAA, privacy, information security, and client/program verification requirements before discussing protected information.
Route clinical questions, legal inquiries, complaints, and escalated issues to the appropriate supervisor, Tier-2 resource, or specialized internal team using established escalation paths.
Follow Omega and client policies, procedures, scripts, quality standards, and security requirements while handling protected health information and other confidential data.