Job Description
Job Description
In general, the Key Accounts Case Manager will be responsible for the following tasks:
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Review and interpret prescriptions to ensure appropriate therapies.
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Review medication policies to ensure compliance with requirements for billing purposes.
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Transcribe prescription data in preparation for Pharmacist verification.
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Contact all new patients to inform them of prior authorization requirements and welcome them to Alivia Specialty Pharmacy.
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Gather all necessary information and documents to support the approval request to the Health Plan or PBM.
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Communicate and send necessary documents to insurance companies or other payers to fulfill prior authorization requirements.
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Answer incoming pharmacy calls with excellent customer service standards and follow up on pending internal or external tasks.
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Meet the quantitative and qualitative production standards set by management.
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Obtain the patient’s medication list for DUR research.
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Submit and review prescription drug insurance claims to be delivered to patients and providers.
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Refer to the Patient Assistance Program department in cases where the patient cannot afford deductibles.
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Develop relationships and act as a liaison with physicians, patients, infusion centers, manufacturers, and Patient Assistance Programs.
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Identify and resolve rejected requests by health plans, including facilitating access to comparable medication regimens; refer to pharmacist in case of potential pharmaceutical alternatives.
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Monitor assistance balances for each enrolled patient to ensure funding is available through the completion of therapy (e.g., financial aid).
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Communicate medication deductible as applicable.
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Maintain continuous communication with the medical office and/or infusion center.
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Identify and follow up on refill dates to ensure patients receive medications on time in accordance with the treatment plan.
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Other duties: perform or assist with any operation as needed to maintain workflow and meet timelines and quality standards; participate in meetings and working groups prepared by management or colleagues; stay updated on new developments, requirements, and policies.
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Escalate any extraordinary situation to the supervisor or manager; availability to attend weekly meetings.
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Other duties as assigned by the supervisor.
Minimum Requirements:
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Experience in Case Management.
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Ability to communicate in English, including reading comprehension, verbal communication, and written communication.
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Exemplary communication, customer service, and relationship-building skills with clients; including listening, speaking, and writing in both Spanish and English.
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Associate Degree as Pharmacy Technician is required.
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Valid Pharmacy Technician license is required.
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Specialized training in benefits access and pharmacy/medical requirements is preferred.
EEOC F/M/D/V