Mc Rx

JOB RESPONSIBILITIES

• Process PAP applications electronically, utilizing the pharmacy CRM software systems and secure designated email accounts.
• Process fax queues, emails, answer incoming calls and adhere to all thresholds for PAP case review and management.
• Maintain clear communication and documentation with provider offices, patients and pharmacy account managers.
• Work closely with provider office point of contact(s) to obtain updated information in order to obtain missing supporting documents that are required for PAP eligibility.
• Input accurate and clear data entry of call logs, important case notes and authorization details into CRM system.
• Verify the accuracy and quality of data entry within PAP case documentation.
• Ability to confirm whether a therapy is complete and if a PAP renewal is needed.
• Initiate and follow-up on PAP renewal requests as assigned.
• Create and complete PAP data reports as assigned by the reimbursement director.
• Cross trained in the area of Rx Prior authorizations and Rx Appeal workflows to assist fellow reimbursement team members as needed.
• Contact patient’s insurance company to verify coverage, initiate authorizations, provide clinical documentation and follow up on previously submitted authorizations.
• To safeguard, protect and always demonstrate proper handling of protected health information in accordance with all HIPAA laws and ProCare Rx policies/procedures.
• Assess, prioritize and resolve client issues using good listening and comprehension skills.
• Works cooperatively and provides coverage for responsibilities of co-workers when assigned or as the need arises.
• Assist the reimbursement director with supervising and on-going training of new and/or existing PAP coordinators.
• Demonstrate working knowledge of all facets of the role, relevant regulations & organizational and departmental policies & procedures.
• Escalate issues to management as appropriate.
• Perform other duties as assigned to support ProCare Rx / ProMod Rx.

QUALIFICATIONS AND REQUIREMENTS
Previous Experience:

• Strong understanding of medical terminology, insurance plans and authorization processes.
• Bilingual English/Spanish is a plus.
• Minimum 3 years of pharmacy or healthcare experience required.
• Minimum 1 year management experience of a team of 5 or more employees, preferred not required.
• Working in a fast-paced environment for 3+ years is required.
• Ability to manage cases from multiple clientele programs and follow program business rules.
• Proficiency with data entry functions and Microsoft applications required.
• Ability to work independently and on a team.
• Excellent communication, problem solving and customer service skills.
• Strong organizational /interpersonal skills; attention to detail and the ability to multitask proficiently.
• Ability to use multiple PC monitors and navigate through several software systems effectively.

Education:

• High School Graduate required, College degree preferred.
• State Pharmacy Technician registration or PTCB National Certification preferred.

Physical Demands:

• Requires sitting, standing, and occasional light lifting.

The Perks of Joining Our Team:

We believe in taking care of our team.  You'll enjoy a comprehensive benefits package designed to support your well-being and financial future:

• Comprehensive Health Benefits: Medical, Dental, Vision, Short-Term/Long-Term Disability Insurance, Life insurance.
• Time to Recharge: Paid vacation and holiday pay.
• Focus on Your Wellness: We offer a robust Employee Wellness Program.
• Invest in Your Future: 401 k with a company match.
• Support System: Employee Assistance Program provides confidential support and counseling.
• Get Rewarded for Referring Great People:  Employee referral program.

ProCare Rx will never ask for a financial commitment from an applicant, as part of our recruitment process.  All interviews are conducted in-person OR through video conference invitations from official company emails.  For inquiries, please contact our official recruitment team at HumanResources@procarerx.com.

ProCare Rx is an Equal Opportunity Employer.