Care Coordinator

About Us

SMP is a national, award-winning fertility pharmacy that prides itself in exceptional customer service and competitive pricing. We are also an award-winning specialty pharmacy that focuses on providing the best programs and services to help our patients manage their chronic conditions. We have a state-of-the-art compounding facility that can customize our patients’ medication to the exact dosage and strength their doctor prescribes. Our retail pharmacy refills and ships all our patients’ medications in one box for an easy process, making prescription ordering and refills simple and easy. The pharmacy is a fast-paced environment, where each interaction has intention and care, and the team works together for a shared purpose.

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. 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 on specific denial reason and patient's 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 on 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 company's 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

• 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 data 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.