JOB RESPONSIBILITIES
- Process PAP applications electronically utilizing the pharmacy CRM software systems and secure designated email accounts.
- Process fax queues emails answer incoming calls and adhere to all thresholds for PAP case review and management.
- Maintain clear communication and documentation with provider offices patients and pharmacy account managers.
- Work closely with provider office point of contact(s) to obtain updated information in order to obtain missing supporting documents that are required for PAP eligibility.
- Input accurate and clear data entry of call logs important case notes and authorization details into CRM system.
- Verify the accuracy and quality of data entry within PAP case documentation.
- Ability to confirm whether a therapy is complete and if a PAP renewal is needed.
- Initiate and follow-up on PAP renewal requests as assigned.
- Create and complete PAP data reports as assigned by the reimbursement director.
- Cross trained in the area of Rx Prior authorizations and Rx Appeal workflows to assist fellow reimbursement team members as needed.
- Contact patients insurance company to verify coverage initiate authorizations provide clinical documentation and follow up on previously submitted authorizations.
- To safeguard protect and always demonstrate proper handling of protected health information in accordance with all HIPAA laws and ProCare Rx policies/procedures.
- Assess prioritize and resolve client issues using good listening and comprehension skills.
- Works cooperatively and provides coverage for responsibilities of co-workers when assigned or as the need arises.
- Assist the reimbursement director with supervising and on-going training of new and/or existing PAP coordinators.
- Demonstrate working knowledge of all facets of the role relevant regulations & organizational and departmental policies & procedures.
- Escalate issues to management as appropriate.
- Perform other duties as assigned to support ProCare Rx / ProModRx.
QUALIFICATIONS AND REQUIREMENTS
Previous Experience:
- Strong understanding of medical terminology insurance plans and authorization processes.
- Bilingual English/Spanish is a plus.
- Minimum 3 years of pharmacy or healthcare experience required.
- Minimum 1 year management experience of a team of 5 or more employees preferred not required.
- Working in a fast-paced environment for 3 years is required.
- Ability to manage cases from multiple clientele programs and follow program business rules.
- Proficiency with data entry functions and Microsoft applications required.
- Ability to work independently and on a team.
- Excellent communication problem solving and customer service skills.
- Strong organizational /interpersonal skills; attention to detail and the ability to multitask proficiently.
- Ability to use multiple PC monitors and navigate through several software systems effectively.
Education:
- High School Graduate required College degree preferred.
- State Pharmacy Technician registration or PTCB National Certification preferred.
Physical Demands:
- Requires sitting standing and occasional light lifting.
ProCare Rx will never ask for a financial commitment from an applicant as part of our recruitment process. All interviews are conducted in-person OR through video conference invitations from official company emails. For inquiries please contact our official recruitment team ator email us at
ProCare Rx is an Equal Opportunity Employer.
Required Experience:
IC