Remote Healthcare Representative

Randstad USA
Published
October 17, 2020
Location
Lewisville, TX
Category
Job Type

Description

job summary:

Role: Case Manager

Program: Reverification / Gilenya Go

What Individualized Care contributes

Delivering an exclusive model that fully integrates direct drug distribution to site-of-care with noncommercial pharmacy services, patient access support, and financial programs of Client's Subsidiary, helps specialty pharmaceutical manufacturers have a greater connection to the customer experience and better control of product success. Personalized service and creative solutions executed through a flexible technology platform means providers are more confident in prescribing drugs, patients can more quickly obtain and complete therapy, and manufacturers can directly access more actionable insight than ever before. With all services centralized in our custom-designed facility outside of Dallas, Texas, Subsidiary helps manufacturers rethink how far their products can go.

Accountabilities

- Monitor system accounts for new Patient cases

- Conduct outbound calls to patients to confirm approval/denials of coverage, co-pays and verification of specialty pharmacy that will dispensing their medication

- Contact insurance companies as required to obtain and enter accurate benefit information to positively impact insurance processing and minimize rejections

- Mediate effective resolution for complex payer/pharmacy issues toward a positive outcome to deescalate

- Place outbound calls to patients to assess for eligibility for co-pay and financial assistance

- Answer minimal inbound calls from doctors and/or patients checking on status of case

- Maintain quality while providing an empathetic and supportive experience to the patients, providers, and physician offices

- Resolve patient's questions and concerns regarding status of their request for assistance

- Enter detailed information into company proprietary software while conversing via telephone

- Steward patient accounts from initial contact through final approval/denial

- Process all patient applications in accordance to set policy, procedures and PHI compliance

- Speak with manufacturer field team members on case updates via phone or by email

- Works internally with team members regarding patients' cases

- Ability to identify, document and submit Adverse Events during customer contact or via received documentation

- Conduct research associated with alternative funding or foundations to ensure patient has required information to receive product

Qualifications

- Minimum of HS diploma; additional education preferred

- Previous healthcare experience with insurance or in pharmaceutical industry, preferred

- Pharmacy benefits management experience preferred with specific knowledge of Medicare, Medicaid and commercially insured payer common practices and policies, preferred

- Previous prior authorization and appeals experience highly desired

- Knowledge of ICD coding, preferred

- Intermediate Microsoft skills with specific experience with Excel

- Organized with the ability to prioritize multiple, concurrent assignments and work with a sense of urgency

- Exceptional communication skills both verbally and written

- Self-starter with demonstrated initiative, creativity and a willingness to learn

Desired Attributes:

- Willingness to learn

- Self-starter

- Quality

- Attention to detail

- Adaptable

- Focus

- Organized

- Anticipating any issues

- Detailed

- Attentiveness

- Compassionate

- Empathy

What is expected of you and others at this level

- Effectively applies knowledge of job and company policies and procedures to complete a variety of assignments

- In-depth knowledge in technical or specialty area

- Applies advanced skills to resolve complex problems independently

- May modify process to resolve situations

- Works independently within established procedures; may receive general guidance on new assignments

- May provide general guidance or technical assistance to less experienced team members

 

location: Lewisville, Texas

job type: Contract

work hours: 8 to 4

education: Bachelor's degree

experience: 2 Years

 

responsibilities:

Accountabilities

- Monitor system accounts for new Patient cases

- Conduct outbound calls to patients to confirm approval/denials of coverage, co-pays and verification of specialty pharmacy that will dispensing their medication

- Contact insurance companies as required to obtain and enter accurate benefit information to positively impact insurance processing and minimize rejections

- Mediate effective resolution for complex payer/pharmacy issues toward a positive outcome to deescalate

- Place outbound calls to patients to assess for eligibility for co-pay and financial assistance

- Answer minimal inbound calls from doctors and/or patients checking on status of case

- Maintain quality while providing an empathetic and supportive experience to the patients, providers, and physician offices

- Resolve patient's questions and concerns regarding status of their request for assistance

- Enter detailed information into company proprietary software while conversing via telephone

- Steward patient accounts from initial contact through final approval/denial

- Process all patient applications in accordance to set policy, procedures and PHI compliance

- Speak with manufacturer field team members on case updates via phone or by email

- Works internally with team members regarding patients' cases

- Ability to identify, document and submit Adverse Events during customer contact or via received documentation

- Conduct research associated with alternative funding or foundations to ensure patient has required information to receive product

 

qualifications:

Qualifications

- Minimum of HS diploma; additional education preferred

- Previous healthcare experience with insurance or in pharmaceutical industry, preferred

- Pharmacy benefits management experience preferred with specific knowledge of Medicare, Medicaid and commercially insured payer common practices and policies, preferred

- Previous prior authorization and appeals experience highly desired

- Knowledge of ICD coding, preferred

- Intermediate Microsoft skills with specific experience with Excel

- Organized with the ability to prioritize multiple, concurrent assignments and work with a sense of urgency

- Exceptional communication skills both verbally and written

- Self-starter with demonstrated initiative, creativity and a willingness to learn

 

skills: Other

Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

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