Patient Services Specialist

AmerisourceBergen

205d • Remote

About The Position

The Patient Services Specialist is responsible for initiating, researching, completing, submitting, and tracking Patient Services Program applications for assigned facilities. The incumbent is responsible for conducting benefit verification and completing necessary third-party prior authorizations, reimbursement activities, patient assistance, and copay program enrollments. They may also coordinate refill calls, perform documented adherence activities, and coordinate dispensing for specialty medications, high-cost prescriptions, and/or infusion medications. This role requires proactive interaction with facility staff, patients, payers, and patient assistance programs (PAP). Occasional travel may be required.

Requirements

• This position requires broad training in fields such as Medical Office Administration, Social Work, Medical Records/Billing, Benefit Verification, Patient Financial Services, Pharmacy, Nursing, or similar vocations generally obtained through completion of a 2-year Associate Degree, technical vocational training, or equivalent combination of experience and education.
• Pharmacy Technician Certification Board (PTCB) or Certified Medical Assistant (CMA) or state certification may be required, contingent on client requirements.

Nice To Haves

• Bachelor's degree program preferred.

Responsibilities

• Performs patient onboarding, benefit verification, prior authorization, and appeals processes, as needed, on behalf of patients and their physician to facilitate the process between the doctors' office and pharmacy to triage and streamline prescription fulfillment.
• Provides above services for a health system's ambulatory pharmacy, specialty pharmacy and/or outpatient infusion center environment, as requested.
• Interacts with patients and providers to obtain insurance benefits and patient information needed to request prior authorizations so that medications and other services rendered are reimbursed by payer.
• Ensures that patient-specific reimbursement related information is obtained and available for review and for tracking of replacement product, including maintenance of files and documentation for PAP application submissions.
• Obtains appropriate signatures and documentation for completed PAP applications prior to submission of the application to the respective PAP.
• Completes patient adherence activities that may include notification of upcoming refills, coordination, tracking, and confirmation of prescription delivery.
• Works within health system's electronic medical record system and other applicable systems (i.e., IndiCare™) to support workflow management and to document activities (i.e., retrieve information needed to deliver services, communicate status, and document outcome).
• Provides integrated services to the health system and its component parts to increase prescription capture rate, improve patient outcomes and reduce readmissions.
• Resolves barriers proactively that may affect reimbursement at assigned facilities and provides detailed updates to the Patient Assistance Services Management when unable to resolve independently.
• Establish business relationships with assigned clinic staff, pharmacy, and hospital contacts, keeping them informed of significant changes in site-specific recovery potential based on changes to PAPs.
• Readily assists on special projects within job scope to improve reimbursement optimization when requested by management.
• Communicates patient and provider feedback to PHS management to enhance process improvement to enhance continuity of care.
• Interfaces appropriately with assigned key account associates with information relevant to additional products and services provided by Cencora and its subsidiaries.
• Demonstrates flexibility and adapts to changes in payer, pharmacy and patient assistance program processes and requirements.
• Provides temporary coverage to support clients and patients in the event of onsite resource absences.
• Performs related duties as assigned.

Benefits

• Medical, dental, and vision care.
• Backup dependent care.
• Adoption assistance.
• Infertility coverage.
• Family building support.
• Behavioral health solutions.
• Paid parental leave.
• Paid caregiver leave.
• Training programs.
• Professional development resources.
• Opportunities to participate in mentorship programs.
• Employee resource groups.
• Volunteer activities.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Merchant Wholesalers, Nondurable Goods
• Education Level: Associate degree