Patient Access Coordinator – Call Center

Full Time

Website Kroger

POSITION INFORMATIONPosition Title : Patient Access CoordinatorSource Job Code: 2581733Source Job Code Description: KSP-RX/PATIENT ACCESS COORDINATOREnterprise Job Code: 125001KnowMe Department/Family: JDMS OperationsPosition Supervises: N/APay Level: N/AFLSA Status: Non-ExemptRevised Date: 08/18/2020POSITION SUMMARYPerform 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. Demonstrate the company’s core values of respect, honesty, integrity, diversity, inclusion, and safety.ESSENTIAL JOB FUNCTIONSCommunicate with patients to obtain information required to process prescriptions, refills, access benefits and apply charges against co-pay cardsInvestigate and verify benefits for pharmacy and medical third-party claims for assigned casesObtain prior authorizations; initiate requests, track progress, and expedite responses from insurance carriers and other payers, and maintain contact with customers to keep them continuously informedReview for accuracy of prescribed treatment regimen prior to submission of authorizationFacilitate appeals process between the patient, physician and insurance company; compose clinical appeals letters based off of specific denial reason and patient’s clinical presentation and coordinate appointment of representative documentComplete status check with insurance company regarding receipt/outcome of prior authorization and appeal; obtain approval information and activates copay cards based off of eligibility and specific drug prescribedTrack, report and escalate service issues arising from requests for authorizations, financial assistance or other issues that delay serviceNotify patients when their prescription has been transferred and follow up with specialty pharmacy to confirm the prescription was received (in some jurisdictions)Coordinate verbal transfer by a pharmacist if specialty pharmacy has no record of prescription (in some jurisdictions); confirm with patient that prescription was received from alternate specialty pharmacyComplete a series of assessments mandated by either manufacturer contracts or operations and facilitates patient enrollment with manufacturerHubs when requiredDocument case activity, communications and correspondence in computer system to ensure completeness and accuracy of patient contact recordsEnsure 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 qualityPerform or assist with any operations, as required to maintain workflow and to meet business needsPerform other related duties as assignedMust be able to perform the essential job functions of this position with or without reasonable accommodationBEHAVIORS/SKILLSPUTS THE CUSTOMER FIRST:Anticipates customer needs, champions for the customer, acts with customers in mind, exceeds customers’ expectations, gains customers’ trust and respect.COMMUNICATES EFFECTIVELY AND CANDIDLY:Communicates clearly and directly, approachable, relates well to others, engages people and helps them understand change, provides and seeks feedback, articulates clearly, actively listens.ACHIEVES RESULTS THROUGH TEAMWORK:Is open to diverse ideas, works inclusively and collaboratively, holds self and others accountable, involves others to accomplish individual and team goals.LEADS THROUGH POSITIVE INFLUENCE:Demonstrates strong character; builds partnerships; models a conscious balance between work and personal life; takes personal responsibility for own development; role models leadership qualities such as motivation, inspiration, passion and trust.COACHES AND DEVELOPS OTHERS:Page 1 of 2Develops and cares about associates, builds effective teams, helps people be their best, values and manages diversity, provides candid and constructive feedback.LEADS CHANGE AND INNOVATION:Challenges the status quo, embraces technology, puts forward creative ideas, champions and implements process improvements, gathers the ideas of others, demonstrates good judgment about which ideas will work.EXECUTES WITH EXCELLENCE:Is action oriented, drives for results, sets clear expectations and milestones, reviews progress, acts decisively, solves problems, can be counted on to consistently meet or exceed goals.PROVIDES CLEAR AND STRATEGIC DIRECTION:Plans and organizes well, sets a clear and simple course of action, stays focused on the most important priorities, has the ability to visualize and plan for the future, understands the industry and marketplace.SAFETY AWARENESS:Identifying and correcting conditions that affect employee safety; upholding safety standards.MINIMUM POSITION QUALIFICATIONSHigh School Diploma or GED1 year of proven work experience in a healthcare or customer service industrySuperior telephone customer service skillsStrong organization skills as well as attention to detailExcellent knowledge of insurance benefit investigation process and techniquesDemonstrated ability to manage a range of priorities and meet time commitmentsExcellent data management software skills with demonstrated adaptability to internal systemsDemonstrated strength in listening, oral and written communications in EnglishDESIRED PREVIOUS JOB EXPERIENCE/EDUCATIONAny additional training in pharmacy/medical benefit access and requirementsAny healthcare experience with a basic understanding of clinical terms and benefits investigationAny previous experience in a call center preferred where performance was measuredPharmacy Technician CertificationPOTENTIAL CAREER PATH FROM THIS POSITIONLead Patient Access CoordinatorSupervisor, Patient AccessPage 2 of 2Job Type: Full-timePay: $16.00 – $18.00 per hourBenefits:401(k)401(k) matchingDental insuranceDisability insuranceEmployee assistance programEmployee discountHealth insuranceLife insurancePaid time offProfessional development assistanceRetirement planTuition reimbursementVision insuranceSchedule:8 hour shiftDay shiftMonday to FridayNo weekendsCOVID-19 considerations:Surfaces sanitized regularly; non-vaccinated associates required to wear masks.Education:High school or equivalent (Required)Experience:Benefits investigation: 1 year (Required)Prior authorization: 1 year (Required)Work Location:One locationWork Remotely:NoWork Location: One locationShow more

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