Customer Care Specialist

About the role

Under the general supervision of the Reimbursement Supervisor, the Customer Care Specialist performs various reimbursement and call center functions, including manufacturer services (“HUB”) intake process, pharmacy clearance, accurate and timely claim submission, collection activity, payment posting, and refunds.

Responsibilities

• Handle inbound and outbound reimbursement calls.
• Accurately enter all inbound faxes such as new referrals, refill prescriptions, reimbursement documents, and HUB documentation in a timely manner.
• Ensure confidentiality of all patient accounts by following HIPAA guidelines and adhering to all company HIPAA policies and procedures.
• Document adverse events as they are reported.
• Verify benefits and coverage information for each patient’s prescription.
• Accurately communicate insurance benefits to specialty pharmacy patients.
• Obtain prior authorizations and appeals for patients’ prescriptions.
• Process specialty pharmacy claims accurately and timely.
• Post specialty pharmacy cash receipts.
• Serve as a backup to the Revenue Cycle Management Associate, including collection activities, claims processing, rejection solution, and phone coverage.
• Know acceptable reimbursement ranges for each AnovoRx drug and convert reimbursement rates expressed in WAC and pre-settlement AWP to post-settlement AWP equivalency.
• Apply the Company’s policy on restrictions and acceptable waiver of co-payments and provision of reduced price or free goods.
• Adhere to drug manufacturers' business rules during the patient onboarding process and provide manufacturer assistance to patients as needed.
• Maintain regular and reliable attendance.
• Perform other work-related duties as assigned by supervisor or manager.

Requirements

• High school diploma or equivalent; Associate's or Bachelor's degree preferred.
• At least one year of experience in reimbursement or insurance verification.
• Highly motivated, people-friendly, organized, and detail-oriented.
• Excellent computer skills; proficient in Microsoft Office Suite (Word, Excel, PowerPoint).
• History evidencing reliability and consistency in timeliness, attendance, and quality of work.
• Professional demeanor on the phone and in person.
• Strong verbal and written communication skills.