Patient Care Associate

About the role

A typical day in this role will include ownership of your patients' cases from initiation to closure, including benefit investigations, prior authorizations/denial appeals, determining financial qualifications for assistance programs, and assisting patients or other callers/stakeholders through resolution (via email, inbound/outbound calls, and using our patented technology, PharmaCord Lynk) by using critical thinking skills and knowledge of the program and industry rules and standards.

Responsibilities

• Relationship Management
• Builds trusted relationships with patients, prescribers, client stakeholders through proactive communication, timely and accurate execution of deliverables, and demonstrated relentless passion for helping patients.
• Manages all relationships in a manner that adheres to healthcare laws and regulations.
• Communications
• Performs program welcome calls to patients.
• Performs post-Benefit Investigation calls to patients and physicians explaining coverage options.
• Manages all client inquiries unable to be determined by client through reporting.
• Manages HCP inquiries, as applicable, pursuant to business rules.
• Inbound Call Management
• Manages inbound calls as directed by the program-approved FAQs.
• Triage patients to internal or external resources as appropriate.
• Personalized Case Management
• Provides personalized case management to patients and HCPs including outbound communication to HCPs and patients to communicate benefit coverage and next steps in obtaining coverage.
• Leverages electronic tools to identify benefits and payer coverage; completes manual benefit investigation as needed.
• Identifies and communicates patient's plan benefit coverage including the need for prior authorization, appeal, tier exception, and/or formulary exclusions.
• Coordinates nurse teach with field-based nurse educators, as applicable to program.
• Supports adherence services through coordination of nurse follow-up, as applicable to program.
• Identifies peer support resources for patients.
• Coordinates shipment of product through patient assistance program and/or bridge program from the PharmaCord pharmacy.
• Proactively communicates needs for reverification of prior authorization or re-enrollment for patient assistance program.
• Reports adverse events, product complaints, special situation reports, and/or medical inquiries received in accordance with SOPs and the Business Rules.
• Documents all activities within the PharmaCord Lynk system in accordance with business requirements.
• Benefit Verification
• Performs patient-level benefits verifications as applicable for all major medical and pharmacy benefits plans.
• Completion of the template forms that provide patient-level benefits Coverage Determination Summary.
• Coordination of prior authorizations based on payer guidelines and in compliance with law, regulation, or guidance.
• Determination of patient's eligibility based upon program criteria for qualification.
• Communicates the patient's eligibility to the patient, healthcare provider, and/or consignment pharmacy.
• Benefit Determination
• Reviews patient assistance enrollment forms and any supporting documentation to assess patient eligibility for participation as per SOPs and program guidelines.
• Determines patient's eligibility based upon program criteria for qualification.
• Communicates the patient's eligibility to the patient, healthcare provider, and/or consignment pharmacy.
• Adherence Services
• Supports adherence services through coordination of nurse follow-up, as applicable to program.
• Reporting
• Reports adverse events, product complaints, special situation reports, and/or medical inquiries received in accordance with SOP and good manufacturing practices.
• Other Tasks
• Provides timely feedback to the company regarding service failures or customer concerns.
• Effectively uses our internal technology platform, Lynk, to complete claims processing and keep workflows moving.
• Communicate with key medical practice accounts, sales representatives regarding the status of cases. Provide consultative services where issues arise on how obstacles can be overcome to get patient on paid therapy.

Qualifications

• Successful candidates possess the following personal attributes:
• Detail oriented.
• Professional telephone etiquette.
• Self-awareness of your own emotions and the potential impact on others.
• Basic computer knowledge.
• Ability to multitask effectively.
• Ability to recognize emotions and their effects.
• Sureness about self-worth and capabilities.
• Manage disruptive impulses.
• Maintain standards of honesty and integrity.
• Takes responsibility for performance.
• Adapts and handles change with flexibility.
• Is innovative and open to new ideas.
• Achievement driven; constant striving to improve or to meet a standard of excellence.
• Aligns with the goals of the group or organization.
• Ready to take initiative and act on opportunities.
• Pursues goals persistently despite obstacles and setbacks.
• Is service oriented and anticipates, recognizes, and meets needs of others, including patients and care partners.
• Clear and concise communication.
• Positive attitude!