Patient Acccess Coordinator Appeals
- Lake Mary, FL 32746, USA
Here at CiNQ Recruitment, we believe in finding the right fit, for you and our clients. Whether you seek long-term employment solutions for your business or your next career move, we understand the importance of individual and business needs. With over 30 years of successful staffing and recruiting experience, we excel at providing passive candidates with the right skills and cultural fit for specialized positions. Here is the opportunity to work with an exciting pharmaceutical company.
Perform duties to investigate, verify and track patient insurance eligibility for medication services; initiate and obtain authorization or reauthorization for services, working within the limits of standard or accepted practice.
- Conduct comprehensive benefit investigation for new or existing infusion patient referrals. Evaluate pharmacy benefit plans and medical benefit plans.
- Verify monthly eligibility for existing patients and conduct new benefits investigation if insurance changes.
- Obtain clinical, lab, and medical testing documentation from physicians’ offices for submission of prior authorization. Track prior authorizations and reauthorizations through the process until approved.
- Communicate with patients, physicians, and other departments on benefits and the status of authorization and reauthorization requests. Communicate denials to physicians’ offices and provide follow-up details on the peer to peer or appeal options.
- Regularly communicate the status of the intake process to other departments, including nursing, pharmacy, and sales.
- Provide explanation and paperwork for Care Support Program to patients who express financial hardship. Utilize manufacturer co-pay cards as appropriate.
- Identify in-network or mandated pharmacy providers if unable to service a patient due to insurance constraints. Communicate related information to the patient and the physician offices and triage referral as directed.
- Communicate clinical inquiries to pharmacy or nursing team and arrange for direct patient communication or provide responses to patients, as appropriate. Identify opportunities for counseling by Registered Pharmacists or Nurse Counselors and make referrals as appropriate.
- Build and maintain effective business relationships with prescribers treating assigned set of disease states, and provide ongoing communication of specific case-related information as appropriate.
Pay Rate: $16-18/ hr
Hours of Operation: 8 AM -8 PM, shift varies within timeframe
- 1 to 3 years of pharmacy benefits investigation
- 1 to 3 years of benefits investigation experience with a non-insurance owned specialty pharmacy
- Reimbursement experience
- Experience finding claims and getting supporting documentation for the appeals. Calling doctor offices, medical facilities, and labs
All your information will be kept confidential according to EEO guidelines.