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.

Position Summary:

Perform duties to assist patients with access to benefits and co-pay cards, and schedule delivery of prescriptions provided through the specialty pharmacy, working within the limits of standard or accepted practice.

Essential Functions:

• Communicate with patients to obtain information required to process prescriptions, refills, access benefits and apply charges against co-pay cards, and build trusted and enduring customer relationships that yield loyalty.
• Investigate and verify benefits for pharmacy and medical third party claims for assigned cases. May communicate with financial assistance team of drug manufacturers to apply for and secure financial assistance for patient when assigned.
• Obtain prior authorizations; initiate requests, follow up to provide additionally required information, track progress, and expedite responses from insurance carriers and other payers, and maintain contact with customers to keep them continuously informed. Review for accuracy of prescribed treatment regimen prior to submission of authorization.
• Facilitate appeals process between the patient, physician and insurance company by requesting denial information and facilitates obtaining the denial letter from the insurance, patient or physician. Composes clinical appeals letters based off of specific denial reason and patients clinical presentation. Ensures all clinical information and documentation are obtained prior to appeal submission. Coordinates appointment of representative document with patient and physician office.
• Completes status check with insurance company regarding receipt of prior authorization and appeal and approval or denial status. 

Required:

• High School Diploma
• Min. 1 year proven work experience in the healthcare field.
• Specialty Background
• Jack of all trades within the PAC role – has experience in benefits investigation and has done full cycle prior authorization.
• Managed appeals and denials – prepare and submit appeal letter, follow up, run test claims.
• Detail - oriented while communicating with patients on medication refills and intake.
• Financial responsibility conversations and knowledgeable in major medical as well as activating co-pay.
• Patient management program enrollment and new patient onboarding.
• Excellent communicator with patients, insurers, co-workers, and sales representative.
• Personable and feel comfortable with intake process.

Preferred:

• Infusion – Background in IVIG and Home Infusion
• Call Center background

Shift: Between 8:00am – 6:00pm

Comp:  $19 - $20

All your information will be kept confidential according to EEO guidelines.