Care Coordinator

Position Summary

We are seeking a Care Coordinator (CC) to facilitate reimbursement and access to medications for patients through payer research and HCP education and support. This position plays a key role in supporting the patient services team, ensuring alignment with organizational goals, operational excellence, and compliance standards.

Key Responsibilities

• Engage with HCPs and their staff using a multi-channel approach to enhance experience, utilizing approved tools, to support and address questions about product coverage and requirements needed for reimbursement.
• Support the entire reimbursement journey from patient enrollment or initiation, access determination, and payer prior authorization processes through appeals/denials requirements.
• Educate HCPs and office staff on available patient assistance programs and explain the importance of their role in facilitating access to therapy for appropriate, eligible patients.
• Serve as payer and pharmacy expert for a defined territory/geography and proactively communicate changes to key stakeholders, both internal and external; coordinate support with other patient service team members or clients as appropriate.
• Identify market access trends from local, regional, or national payers in an assigned territory/geography, and partner with internal and client teams to enable appropriate patient access and/or support patient pull-through programs.
• Maintain and grow knowledge of national, regional, local, and account market dynamics, including coverage and prior authorization requirements.
• Analyze an assigned territory using reporting and analytics tools to execute comprehensive territory support, facilitate strategic decision making, and identify trends and areas of focus.
• Monitor and meet program SLAs, KPIs, and other established metrics.
• Adapt and pivot quickly to manage change and complexity, including flexing as markets, policies, and dynamics change; proactively managing through conflicts; and navigating the complexity of accounts and the patient journey.
• Maintain and grow knowledge of hub and specialty pharmacy channels to improve HCP office and patient support.
• Collaborate with client Reimbursment Access Managers to support territories and HCP accounts.
• Identify key customer insights through effective questioning, critical thinking, and problem solving; analyze and disseminate data and information as appropriate to partners.
• Execute business in accordance with client values and to the highest ethical, legal, and compliance standards.

Qualifications

• Education: Bachelor's degree or advanced degree preferred.
• Licensure/Certification: Not applicable.
• Experience: Minimum three years' experience in the public or private third-party reimbursement arena or pharmaceutical industry in managed care, clinical support, or sales.
• Skills:
  • Specialty pharmacy, hub, or patient services experience working with HCPs and payers to remove reimbursement barriers to specialty products.
  • Strong functional knowledge of specialty pharmacy and health insurance and benefits (e.g., Medicare Part D, commercial, and Medicaid), with a solid understanding of insurance eligibility, benefit verification, prior authorization, reimbursement coverage, appealing insurance denials, financial assistance, co-pay support, and bridge programs.
  • Knowledge of Centers for Medicare & Medicaid Services (CMS) policies and processes, with expertise in Medicare Part D (Pharmacy Benefit design and coverage policy) a plus.
  • Knowledge of Managed Care, Government, and Federal payer sectors, as well as Integrated Delivery Networks/Integrated Health Systems, a plus.
  • Proficiency in Microsoft Office products required, with advanced knowledge of Tableau, Excel, or other report generators, and the ability to analyze data to determine areas requiring focus.
  • Advanced problem solving, research, and analytical skills.
  • High proficiency with complex patient access CRMs (such as Salesforce.com, Veeva, or CourierHealth) and the ability to efficiently navigate multiple systems while performing specific tasks on each.
  • High proficiency with complex patient access CRMs (such as Salesforce.com, Veeva, or CourierHealth) and the ability to efficiently navigate multiple systems while performing specific tasks on each.
  • High proficiency with complex patient access CRMs (such as Salesforce.com, Veeva, or CourierHealth) and the ability to efficiently navigate multiple systems while performing specific tasks on each.
  • High proficiency with complex patient access CRMs (such as Salesforce.com, Veeva, or CourierHealth) and the ability to efficiently navigate multiple systems while performing specific tasks on each.
  • High proficiency with complex patient access CRMs (such as Salesforce.com, Veeva, or CourierHealth) and the ability to efficiently navigate multiple systems while performing specific tasks on each.
  • High proficiency with complex patient access CRMs (such as Salesforce.com, Veeva, or CourierHealth) and the ability to efficiently navigate multiple systems while performing specific tasks on each.
  • High proficiency with complex patient access CRMs (such as Salesforce.com, Veeva, or CourierHealth) and the ability to efficiently navigate multiple systems while performing specific tasks on each.
  • High proficiency with complex patient access CRMs (such as Salesforce.com, Veeva, or CourierHealth) and the ability to efficiently navigate multiple systems while performing specific tasks on each.
  • High proficiency with complex patient access CRMs (such as Salesforce.com, Veeva, or CourierHealth) and the ability to efficiently navigate multiple systems while performing specific tasks on each.
  • High proficiency with complex patient access CRMs (such as Salesforce.com, Veeva, or CourierHealth) and the ability to efficiently navigate multiple systems while performing specific tasks on each.
  • High proficiency with complex patient access CRMs (such as Salesforce.com, Veeva, or CourierHealth) and the ability to efficiently navigate multiple systems while performing specific tasks on each.
  • High proficiency with complex patient access CRMs (such as Salesforce.com, Veeva, or CourierHealth) and the ability to efficiently navigate multiple systems while performing specific tasks on each.
  • High proficiency with complex patient access CRMs (such as Salesforce.com, Veeva, or CourierHealth) and the ability to efficiently navigate multiple systems while performing specific tasks on each.
  • High proficiency with complex patient access CRMs (such as Salesforce.com, Veeva, or CourierHealth) and the ability to efficiently navigate multiple systems while performing specific tasks on each.
  • High proficiency with complex patient access CRMs (such as Salesforce.com, Veeva, or CourierHealth) and the ability to efficiently navigate multiple systems while performing specific tasks on each.
  • High proficiency with complex patient access CRMs (such as Salesforce.com, Veeva, or CourierHealth) and the ability to efficiently navigate multiple systems while performing specific tasks on each.
  • High proficiency with complex patient access CRMs (such as Salesforce.com, Veeva, or CourierHealth) and the ability to efficiently navigate multiple systems while performing specific tasks on each.
  • High proficiency with complex patient access CRMs (such as Salesforce.com, Veeva, or CourierHealth) and the ability to efficiently navigate multiple systems while performing specific tasks on each.
  • High proficiency with complex patient access CRMs (such as Salesforce.com, Veeva, or CourierHealth) and the ability to efficiently navigate multiple systems while performing specific tasks on each.
  • High proficiency with complex patient access CRMs (such as Salesforce.com, Veeva, or CourierHealth) and the ability to efficiently navigate multiple systems while performing specific tasks on each.
  • High proficiency with complex patient access CRMs (such as Salesforce.com, Veeva, or CourierHealth) and the ability to efficiently navigate multiple systems while performing specific tasks on each.
  • High proficiency with complex patient access CRMs (such as Salesforce.com, Veeva, or CourierHealth) and the ability to efficiently navigate multiple systems while performing specific tasks on each.
  • High proficiency with complex patient access CRMs (such as Salesforce.com, Veeva, or CourierHealth) and the ability to efficiently navigate multiple systems while performing specific tasks on each.
  • High proficiency with complex patient access CRMs (such as Salesforce.com, Veeva, or CourierHealth) and the ability to efficiently navigate multiple systems while performing specific tasks on each.
  • High proficiency with complex patient access CRMs (such as Salesforce.com, Veeva, or CourierHealth) and the ability to efficiently navigate multiple systems while performing specific tasks on each.
  • High proficiency with complex patient access CRMs (such as Salesforce.com, Veeva, or CourierHealth) and the ability to efficiently navigate multiple systems while performing specific tasks on each.
  • High proficiency with complex patient access CRMs (such as Salesforce.com, Veeva, or CourierHealth) and the ability to efficiently navigate multiple systems while performing specific tasks on each.
  • High proficiency with complex patient access CRMs (such as Salesforce.com, Veeva, or CourierHealth) and the ability to efficiently navigate multiple systems while performing specific tasks on each.
  • High proficiency with complex patient access CRMs (such as Salesforce.com, Veeva, or CourierHealth) and the ability to efficiently navigate multiple systems while performing specific tasks on each.
  • High proficiency with complex patient access CRMs (such as Salesforce.com, Veeva, or CourierHealth) and the ability to efficiently navigate multiple systems while performing specific tasks on each.
  • High proficiency with complex patient access CRMs (such as Salesforce.com, Veeva, or CourierHealth) and the ability to efficiently navigate multiple systems while performing specific tasks on each.
  • High proficiency with complex patient access CRMs (such as Salesforce.com, Veeva, or CourierHealth) and the ability to efficiently navigate multiple systems while performing specific tasks on each.
  • High proficiency with complex patient access CRMs (such as Salesforce.com, Veeva, or CourierHealth) and the ability to efficiently navigate multiple systems while performing specific tasks on each.
  • High proficiency with complex patient access CRMs (such as Salesforce.com, Veeva, or CourierHealth) and the ability to efficiently navigate multiple systems while performing specific tasks on each.
  • High proficiency with complex patient access CRMs (such as Salesforce.com, Veeva, or CourierHealth) and the ability to efficiently navigate multiple systems while performing specific tasks on each.
  • High proficiency with complex patient access CRMs (such as Salesforce.com, Veeva, or CourierHealth) and the ability to efficiently navigate multiple systems while performing specific tasks on each.
  • High proficiency with complex patient access CRMs (such as Salesforce.com, Veeva, or CourierHealth) and the ability to efficiently navigate multiple systems while performing specific tasks on each.
  • High proficiency with complex patient access CRMs (such as Salesforce.com, Veeva, or CourierHealth) and the ability to efficiently navigate multiple systems while performing specific tasks on each.
  • High proficiency with complex patient access CRMs (such as Salesforce.com, Veeva, or CourierHealth) and the ability to efficiently navigate multiple systems while performing specific tasks on each.
  • High proficiency with complex patient access CRMs (such as Salesforce.com, Veeva, or CourierHealth) and the ability to efficiently navigate multiple systems while performing specific tasks on each.
  • High proficiency with complex patient access CRMs (such as Salesforce.com, Veeva, or CourierHealth) and the ability to efficiently navigate multiple systems while performing specific tasks on each.
  • High proficiency with complex patient access CRMs (such as Salesforce.com, Veeva, or CourierHealth) and the ability to efficiently navigate multiple systems while performing specific tasks on each.
  • High proficiency with complex patient access CRMs (such as Salesforce.com, Veeva, or CourierHealth) and the ability to efficiently navigate multiple systems while performing specific tasks on each.
  • High proficiency with complex patient access CRMs (such as Salesforce.com, Veeva, or CourierHealth) and the ability to efficiently navigate multiple systems while performing specific