Bilingual Prior Authorization Specialist
- Garden Grove, CA, 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.
Pay Rate: $18-$22/hr
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. Submitting prior authorizations for Specialty Medications. Welcome calls to new patients, aligning their benefits and scheduling their first dose.
- 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. Obtains approval information and activates copay cards based off of eligibility and specific drug prescribed.
- Track, report and escalate service issues arising from requests for authorizations, financial assistance or other issues that delay service, to ensure patient access and to avoid delays that may interrupt therapy.
- 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.
- Completes a series of assessments mandated by either manufacturer contracts or operations and facilitates patient enrollment with manufacturer Hubs when required.
- Document case activity, communications and correspondence in computer system to ensure completeness and accuracy of patient contact records. Ensure that work activities are conducted in compliance with regulatory requirements and the organization’s defined standards and procedures, and in a manner that provides the best available level of service and quality.
- High School Diploma or equivalent required. Some college preferred.
- Additional specialized training in pharmacy/medical benefit access and requirements preferred.
Minimum 1 year experience working with prior authorizations and handling patient phone calls.
- Minimum 2 years proven work experience in a healthcare or customer service industry.
- Healthcare experience with a basic understanding of clinical terms and benefits investigation preferred.
- Previous experience in a call center preferred where there is familiarity with metrics and a high level of accuracy and touches.
- Some jurisdictions where this role is performed may require that associates maintain endorsement as a Certified Pharmacy Technician and report through a Pharmacist Manager, in addition to the above requirements.
All your information will be kept confidential according to EEO guidelines.