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Health Service Specialist

McKessonCary, NC
Hybrid

About The Position

The Claims Processing and Refill Specialist plays a critical role in supporting patients' access to therapy by managing prescription refill requests, processing pharmacy claims, and coordinating resolution of reimbursement-related issues. This role serves as a liaison between patients, healthcare providers, pharmacies, payers, and internal teams to ensure timely medication access and continuity of care. The ideal candidate will possess strong problem-solving skills, attention to detail, and the ability to navigate payer requirements, prescription processing workflows, and patient support services while delivering an exceptional customer experience. Working independently with minimal supervision, this position requires sound judgment, effective communication, and the ability to manage a high volume of cases in a fast-paced healthcare environment. This is a hybrid role and will require two days a week in office at our Cary, NC location.

Requirements

  • Typically requires 3+ years of related experience.
  • 3+ years of customer service, patient advocacy, or healthcare support experience.
  • Excellent verbal and written communication skills with the ability to interact professionally with patients, providers, and healthcare stakeholders.
  • Ability to build trust and maintain positive relationships with a diverse patient population.
  • Strong problem-solving and critical-thinking abilities with the capacity to make sound decisions within established policies and procedures.
  • Proficiency with web-based systems, telephony platforms, and Microsoft Office applications.
  • Exceptional organizational skills and attention to detail.
  • Ability to manage a high-volume workload while maintaining accuracy and quality standards.
  • Comfortable working independently with limited supervision and exercising judgment in routine and moderately complex situations.

Nice To Haves

  • Experience working with patient support programs, reimbursement services, healthcare access programs, specialty pharmacy, or related healthcare environments preferred.
  • Knowledge of HIPAA, patient privacy regulations, and compliance requirements preferred.

Responsibilities

  • Serve as a primary point of contact for patients, caregivers, healthcare providers, and other stakeholders participating in patient support programs.
  • Provide program education, guidance, and ongoing support to help patients navigate treatment-related processes and available resources.
  • Coordinate patient support services, ensuring timely completion of program activities and adherence to established guidelines.
  • Facilitate communication between patients, providers, pharmacies, payers, and internal teams to help address barriers to care and therapy access.
  • Support reimbursement and access-related activities, including benefit investigations, prior authorization coordination, patient assistance programs, and other program services.
  • Conduct outbound and inbound calls to gather information, provide updates, and ensure patients receive the support needed throughout their treatment journey.
  • Accurately document all interactions and case activities within web-based systems while maintaining compliance with company policies and regulatory requirements.
  • Identify and escalate complex issues, patient concerns, or service-related challenges to the appropriate team members for resolution.
  • Collaborate with cross-functional and multidisciplinary teams to improve patient experiences and program outcomes.
  • Manage multiple cases and priorities while meeting quality, productivity, and service-level expectations.

Benefits

  • competitive compensation package
  • annual bonus or long-term incentive opportunities may be offered

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