Job Summary:

Patient Services Specialist I is responsible for conducting benefit verification and completing necessary third party prior authorizations, reimbursement activities, patient assistance and copay program enrollments.  The Patient Services Specialist I also coordinates refill calls, performs documented adherence activities, and coordinates dispensing for specialty medications, high cost prescriptions, and/or infusion medications.  This role requires proactive interaction with physicians, office staff, patients, pharmacies, payers, and patient assistance programs. Occasional travel may be required.

Responsibilities:

• Perform time-sensitive patient services such as patient onboarding, benefit verification, prior authorization, and appeals, as needed, on behalf of patients and their physician to facilitate the process between the doctors’ office and pharmacy to triage and streamline prescription fulfillment.

• Provide above services for a health system’s ambulatory pharmacy, specialty pharmacy and/or outpatient infusion center environment, as requested. 

• Verify benefits on both pharmacy and medical coverage, as appropriate.

• Interact with patients and providers to obtain insurance and patient information needed to request prior authorizations so that medications and other services rendered are reimbursed by payer.

• Operate with a sense of urgency focused on patient care while communicating with clinic staff, pharmacy/infusion center and patient on the status of the request.    

• Complete patient adherence activities that may include notification of upcoming refills, coordination, tracking, and confirmation of prescription delivery.

• Work within health system’s electronic medical record system and other applicable systems to retrieve information needed to deliver services, communicate status and document outcome. 

• Research various payers to understand their prior authorization and appeals processes.

• Utilize software to support workflow management and to document activities. Follow defined policies and procedures, meet productivity and quality expectations. 

• Responsible for facilitating patient enrollment into manufacturer and/or foundation sponsored patient assistance programs.

• Demonstrate flexibility and adapt to changes in payer, pharmacy and patient assistance program processes and requirements.

• Establish client relationships with assigned clinic staff, pharmacy and hospital contacts, maintaining professional communications at all times and keeping them informed of patients’ status and payer challenges.

• Provide integrated services to health system and its component parts to increase prescription capture rate, improve patient outcomes and reduce readmissions.

• Communicate patient and provider feedback to PHS management to enhance process improvement and continuity of care. 

• Provides coverage to support clients and patients in the event of onsite resource absences.

• Performs additional related duties as assigned.

Education:

Normally requires a minimum of two (2) years in fields such as Benefit Verification, Prior Authorization, Medical Billing, Medical Office Administration, Social Work, Medical Records, Patient Financial Services, Pharmacy, Nursing or similar vocations. Bachelor's degree program preferred. Previous prior authorization experience preferred. Healthcare certification is preferred but not required:  Certified Pharmacy Technician (CPhT) obtained through PTCB or other medical certification such as Certified Medical Assistant (CMA). 

Skills and knowledge:

• Ability to communicate effectively both orally and in writing

• Strong organizational skills; attention to detail

• Ability to work quickly and accurately under time and volume constraints

• Ability to be proactive and tenaciously seek solutions under minimum supervision

• Demonstrated competence in Microsoft Excel and Word

• Strong interpersonal skills

• Ability to resolve issues quickly and creatively in order to improve customer satisfaction

• Familiarity with insurance/claims processing, pharmaceutical products, services, software, and drug interactions.

• Good analytical skills

Physical requirements:

The physical demands described here are representative of those that must be met by an associate to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions:

• Sedentary physical activity requiring reaching, sifting, lifting, finger dexterity, grasping, feeling, repetitive motions, talking and hearing.

• Visual requirement is for close vision, distance vision, peripheral vision and ability to adjust focus.

• 75% or more time is spent looking directly at a computer.

• Associate is frequently required to stand, walk (or otherwise be mobile).

• Ability to deal with stressful situations as they arise.

What Cencora offers

We provide compensation, benefits, and resources that enable a highly inclusive culture and support our team members’ ability to live with purpose every day. In addition to traditional offerings like medical, dental, and vision care, we also provide a comprehensive suite of benefits that focus on the physical, emotional, financial, and social aspects of wellness. This encompasses support for working families, which may include backup dependent care, adoption assistance, infertility coverage, family building support, behavioral health solutions, paid parental leave, and paid caregiver leave. To encourage your personal growth, we also offer a variety of training programs, professional development resources, and opportunities to participate in mentorship programs, employee resource groups, volunteer activities, and much more. For details, visit https://www.virtualfairhub.com/cencora

Equal Employment Opportunity

Cencora is committed to providing equal employment opportunity without regard to race, color, religion, sex, sexual orientation, gender identity, genetic information, national origin, age, disability, veteran status or membership in any other class protected by federal, state or local law.

The company’s continued success depends on the full and effective utilization of qualified individuals. Therefore, harassment is prohibited and all matters related to recruiting, training, compensation, benefits, promotions and transfers comply with equal opportunity principles and are non-discriminatory.

Cencora is committed to providing reasonable accommodations to individuals with disabilities during the employment process which are consistent with legal requirements. If you wish to request an accommodation while seeking employment, please call 888.692.2272 or email hrsc@cencora.com. We will make accommodation determinations on a request-by-request basis. Messages and emails regarding anything other than accommodations requests will not be returned

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