Patient Access Representative at TEKsystems

Description:

A typical day in the life of a CASE MANAGER will include the following:

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:

- Perform program welcome calls to patients

- Performs post benefits investigations 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 FAQ's

- Triage patients to internal or external resources as appropriate

PERSONALIZED CASE MANAGEMENT

- Provides personalized case management to patients and HCP's including outbound communication to HCP's and patients to communicate benefits coverage and next steps in obtaining coverage

- Leverages electronic tool to identify benefits and payer coverage; completes manual benefit investigations as needed

- Identifies and communicates patients' plan benefit coverage including the need for prior auth, appeal, tier exception, and/or formulary exclusions

- Uses electronic resources to obtain benefit coverage outcome and if needed ,outbound call to payers and healthcare providers to follow up on proper submission/or outcome

Additional Responsibilities:

- Compassionately deliver an exceptional experience to many patients per day always remembering that every prescription or document belongs to a real person who is looking for thorough efficient management of their records.

- Adjust your approach to their needs by communicating clearly, focusing on the accuracy of the details of their medical records and your mastery of the program requirements, and ensuring their prescriptions or cases are handled timely.

- Reporting of Adverse Events/Product Complaint inquiries received in accordance with SOP and good manufacturer practices

- Provides timely feedback to the company regarding service failures r customer concerns

- Effectively uses internal technology platform 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.

Skills:

Customer service, Benefits administration, Prior Authorization, Benefit verification, Call center, Health insurance, Pharmacy, Insurance, Health care, Microsoft office

Additional Skills & Qualifications:

Requirement for EXECUTIVE CASE MANAGER:

- Bachelors degree required (can substitute for 5 yrs of exp)

- 2 years of experience in insurance reimbursement, patient access, direct patient care and/or patient education required

About TEKsystems:

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.