Patient Services Specialist

Title: Patient Services Specialist

Location: United States-Texas-Carrollton

Job Number: 000022V3Patient

Services Specialist is responsible for conducting benefit verification and

completing necessary third party prior authorizations, reimbursement activities,

patient assistance and copay program enrollments. The Patient Services Specialist also

coordinates refill calls, performs documented adherence activities, and

coordinates dispensing for specialty medications, high cost prescriptions,

and/or infusion medications. This role requires

proactive interaction with physicians, office staff, patients, pharmacies, payers,

and patient assistance programs. Occasional travel may be required.Perform time-sensitive patient

services such as patient onboarding, benefit verification, prior

authorization, and appeals, 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. Provide above services for a

health system’s ambulatory pharmacy, specialty pharmacy and/or outpatient

infusion center environment, as requested.

Verify benefits on both pharmacy

and medical coverage, as appropriate. Interact with patients and

providers to obtain insurance and patient information needed to request

prior authorizations so that medications and other services rendered are

reimbursed by payer. Operate with a sense of urgency

focused on patient care while communicating with clinic staff, pharmacy/infusion

center and patient on the status of the request. Complete patient adherence activities that may

include notification of upcoming refills, coordination, tracking, and confirmation

of prescription delivery. Work within health system’s

electronic medical record system and other applicable systems to retrieve

information needed to deliver services, communicate status and document

outcome. Research various payers to

understand their prior authorization and appeals processes. U tilize software to support workflow management

and to document activities. Follow defined policies and procedures, meet

productivity and quality expectations. Responsible for facilitating patient

enrollment into manufacturer and/or foundation sponsored patient

assistance programs. Demonstrate flexibility and adapt to changes in payer,

pharmacy and patient assistance program processes and requirements. Establish client relationships

with assigned clinic staff, pharmacy and hospital

contacts , maintaining professional communications at all times and keeping

them informed of patients’ status and payer challenges. Provide integrated services to health

system and its component parts to increase prescription capture rate, improve

patient outcomes and reduce readmissions. Communicate patient and provider

feedback to PHS management to enhance process improvement and continuity

of care. Provides temporary coverage to

support clients and patients in the event of onsite resource absences. Performs additional related duties as assigned.

Qualifications: Normally requires a minimum of 2 years in fields such as Benefit Verification, Prior Authorization, Medical Billing, Medical Office Administration, Social Work, Medical Records, Patient Financial Services, Pharmacy, Nursing or similar vocations. Bachelor's degree program preferred. Previous prior authorization experience preferred. Pharmacy Technician Certification Board (PTCB) or state certification as required by Board of Pharmacy preferred or must be willing to obtain within six months of hire Ability to communicate effectively both orally and in writing Strong organizational skills; attention to detail Ability to work quickly and accurately under time and volume constraints Ability to be proactive and tenaciously seek solutions under minimum supervision Demonstrated competence in Microsoft Excel and Word Strong interpersonal skills Ability to resolve issues quickly and creatively in order to improve customer satisfaction Familiarity with insurance/claims processing, pharmaceutical products, services, software, and drug interactions Good analytical skills Job: Operations Jobs