Care Coordinator

Summary:
Perform duties to assist patients with access to benefits, savings programs and schedule delivery
of prescriptions provided through the specialty pharmacy via inbound and outbound calls and web
inquiries.

Essential Duties and Responsibilities:

• Communicate with patients to obtain information required to process prescriptions,
• refills, access benefits and apply charges against co-pay cards.
• Investigate and verify benefits for pharmacy and medical third-party claims for
• assigned cases.
• Obtain prior authorizations; initiate requests, track progress, and expedite
• responses from insurance carriers and other payers, and maintain contact with patients/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.
• Compose clinical appeals letters based off specific denial reason and patients clinical
• presentation. Coordinate appointment of representative document.
• Complete status check with insurance company regarding receipt/outcome of prior
• authorization and appeal. Obtain approval information and activate copay cards based off
• eligibility and specific drug prescribed.
• Track, report and escalate service issues arising from requests for authorizations,
• financial assistance or other issues that delay service.
• Notify patients when their prescription has been transferred and follow up with
• pharmacy to confirm the prescription was received.
• Coordinate verbal transfer by a Pharmacist if specialty pharmacy has no record of
• prescription. Confirm with patient that prescription was received from alternate pharmacy.
• Complete a series of assessments mandated by either manufacturer contracts or
• operations and facilitate patient enrollment when required.
• Document case activity, communications, and correspondence in computer system to
• ensure completeness and accuracy of patient contact records while ensuring HIPAA practices.
• Ensure that work activities are conducted in compliance with regulatory requirements
• and the companys defined standards and procedures, and in a manner that provides the
• best available level of service and quality.
• Collaborate with multiple departments in a customer service / call center setting.
• Perform other related duties as assigned.

Qualifications:
To perform this job successfully, an individual must be able to perform each essential duty
satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or
ability required. Reasonable accommodations may be made to enable individuals with disabilities to
perform the essential functions.

Education and/or Experience:

• High School diploma or equivalent required.
• Must be registered with State of Florida Board of Pharmacy as a Pharmacy Technician or be enrolled as a Pharmacy Technician student with a Board-Certified training program. Current PTCB or ICPT certification preferred.
• Additional training in pharmacy/medical benefit access and requirements preferred.
• A minimum of 1-year proven work experience in a healthcare or customer service industry.
• Excellent date entry skills.
• Healthcare experience with a basic understanding of clinical terms and benefits investigation preferred.
• Previous experience in a call center preferred where performance was measured.