Specialty Program Coordinator

Job Description

Job Description

InfuCare Rx is a leading home infusion provider accredited by URAC and ACHC offering a specialized approach to caring for patients in need of IV therapy and specialty pharmacy services in the homecare setting. We have created an ethical, team oriented, and quality work environment for our employees that cultivates achievement and success.

Job Summary:

InfuCare Rx is seeking an experienced Specialty Program Coordinator to serve as a cross departmental liaison between sales, managed care, intake, nursing, pharmacy operations, and data reporting staff. Duties will include the following but not limited to performing outreach to internal and external customers to ensure timely completion of assignments to meet overall company objectives. Participate in new hire orientation as deemed necessary and act as a resource to the specialty team. Assist in training new specialty intake team members and serve as a resource to them as needed. Serve as a reimbursement expert for the sales operations team and attend sales calls/meetings when requested. Coordinate/advise on needed interaction with Caregivers, Physicians, and other internal and external stakeholders during the execution of the referral. Work in collaboration with National Director of Intake, National Sales Director, Area Sales Directors, Specialty Intake Manager and Specialty Program Manager. Work closely with the team to drive referral process efficiencies including satisfactory turnaround time of patient onboarding and re-authorizations. Maintain familiarity with national and local payers to collaborate with the Managed Care Team on contracting. Support Business Operations and Program Manager in successfully launching new products and enhanced data agreements with manufacturer partners.

Primary Responsibilities:

• Must be experienced with insurance coverage for infusion, specific health plans, and have familiarity with key requirements necessary for specialty benefit checks and authorizations.
• Able to accurately identify guidelines, coverage rules, and obtain prior authorization as well as letters of medical necessity when needed.
• Assist in preparing and reviewing products to validate profitability and reimbursement.
• Identify appropriate payor criteria pursuant to company formulary and preferred product utilization.
• Work closely with Specialty Program Manager to identify trends in patient churn.
• Assist with development and implementation of standardized operating procedures (SOPs) for our specialty business unit.
• Work with department leaders to optimize and streamline processes for assigned business unit.
• Assist with the implementation of standard operating procedures to ensure consistent and uniform processes and workflows.
• Work closely with the data analytics team to validate reports and information to be submitted in accordance to manufacturer data agreements.
• Assist in gathering, validating and processing relevant data related to manufacturer partner agreements.
• Support Pharmacy Operations proactively to help manage medication access for new and current products for Specialty Therapy program.
• Follow established chain of command and communications throughout the organization.
• Perform special tasks or projects as requested.
• Assist with the development, implementation and administration of specialty related intake policies and procedures.
• Communicate and resolve problems with patients/customers, physicians’ offices, referral sources, third party insurance companies, Medicaid, and Medicare and sales team.
• Ability to assess what is needed and work effectively with all members of the Specialty Team including Intake, Pharmacists, Nurses, Sales and Managed Care.
• Ability to work effectively with revenue team to ensure that we maximize billing and collection of insurance receivables.
• Proactively familiarize yourself with the scope of services that are available through the company and understand basic drug terminology and therapies/services provided.
• Actively support company mission, organizational/departmental policies, and procedures.
• Presents a professional appearance and approach with members & other employees; demonstrates honest and ethical behavior. Handles member and employee info with appropriate sensitivity and safeguards to ensure confidentiality and right to privacy, in compliance with HIPAA regulatory requirements.
• Contributes to the effectiveness of the team by working together by supporting, promoting and applying the best practice standards of conduct including those on attendance, mutual respect and support, honoring diversity, effective communication, and improving the work environment.
• Exhibits flexibility when work assignments need to be adjusted to meet service, delivery and workload needs of team.
• Takes initiative to identify, develop and adapt new policies and practices to improve quality of work.
• Serves as liaison with sales management and patient advocacy organizations.
• Review complex referral cases and support team with appeals and letter of medical necessity as needed.

Confidentiality and Compliance

• Maintain confidentiality of patient and proprietary information at all times.
• Observe legal and ethical guidelines for safeguarding the confidentiality of patient and proprietary company information.
• Understand and comply with HIPPA.
• For all activities complies with accreditation, legal, regulatory, government and safety requirements.

Required Qualifications:

• 5+ years working with specialty/home infusion pharmacy.
• Minimum of 3 years of experience as an Intake Authorization Coordinator/Manager.
• Excellent Communication skills including reading, writing, and speaking to effectively handle position responsibilities.
• Proficiency with Microsoft Office suite products.
• Experience with CPR+ Pharmacy Management System.

Physical Demands:

Required to stand, walk, sit, talk and hear; required to use hands to operate vehicles and office equipment; must be able to occasionally lift and/or move up to 25 lbs; specific vision requirements for this job include: close, distance and peripheral vision, and the ability to adjust focus, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position without compromising patient care.

InfuCare Rx is an equal opportunity employer. All employment decisions are made without regard to race, color, religion, national origin, military status, marital status, citizenship/immigration status, sex (including pregnancy and relation conditions, sexual orientation, or gender identity), age (40 and older), disability, genetic information (including employer requests for, or purchase use, or disclosure of genetic tests, genetic services, or family medical history), retaliation for filing a charge, reasonably opposing discrimination, or participating in a discrimination lawsuit, investigation, or proceeding. Background checks and drug screens are part of our hiring process. Affirmative Action/Equal Opportunity Employer, Minority/Female/Disabled/Veteran.

Please click here to view our drug testing policy

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