Care Coordinator - Specialty Pharmacy

Job Description

What we are looking for

Optime Care is looking for a Care Coordinator. We are looking for someone passionate about helping people get the specialized therapies they need. This critical role serves as the first point of contact for patients. They will act as the patient advocate, their champion, guiding patients through the process of obtaining pharmaceuticals not available with chain pharmacies. This position will be required to be in the office 5 days a week, M-F, for the first 120 days.

What the position will be doing

Act as a patient advocate to gain insurance coverage for prescribed therapies.

Welcoming new patients and creating profiles with all the critical information.

Conduct periodic insurance verification and/or authorizations for patient coverage.

File claims for patient prescriptions and orders.

Complete collection activities per client program specifications.

Investigation and benefit explanation to patient, initial and ongoing.

Obtain and maintain Prior Authorizations.

Create patient orders and associated prescription entries for new and refilled prescriptions.

Communicate with prescribers, including requesting new prescriptions.

Bill for RX drugs and administration supplies.

Assist patients with possible financial assistance.

Arrange all necessary documents and materials for initial and ongoing shipments.

Coordinate all deliveries and process any patient returns.

Obtain necessary consent forms for manufacturers or patient support organizations.

Assist pharmacists with day-to-day tasks such as filling prescriptions and entering prescription information into the patient management system for pharmacist verification.

Assist in preparing any ad hoc report request from clients

Other duties as needed or assigned

Necessary Skills, Education & Abilities

High school diploma, or equivalent, required

2 or more years of experience with medical/pharmacy insurance verification including benefit investigation.

Current Missouri BOP Pharmacy Technician license, or Nurse license in good standing.

Knowledge of medical terminology required.

Knowledge of medical/pharmacy insurance benefit language- ie. EOBs, deductibles, out-of-pocket, co-insurance, co-pays, etc.

Ability to define CMS 1500s, provider numbers, CPT, HCPC’s, ICD9, NCPDP and NDC codes/numbers

Knowledge of Medicare and Medicaid billing.

Patient Assistance Program knowledge a plus.

Experience with prior authorization and SMN preparation.

Knowledge of insurance claim appeals.

Computer literate and proficient with Microsoft Office.

Ability to participate in and facilitate group meetings.

Ability to thrive in a fast-paced environment with constantly changing and competing priorities.

Excellent analytical skills and the ability to provide solutions to complex problems.

Ability to be highly transparent, ethical, and driven. Relentless attention to detail, and the ability to be a creative self-starter and team player.

Excellent written and verbal communication skills, and interpersonal skills required.

Willingness to work a flexible schedule.

About us

Optime Care is a Specialty Pharmacy dedicated to providing services to smaller patient communities. We focus on securing insurance coverage, coordinating care, and complying with therapy regimens are only a few examples. Our mission is to minimize the daily impact of living with unique disorders. After just one call, our experts begin to address everything from medication delivery and insurance reimbursement to compliance and education. Every patient receives a proactive service experience tailored to their specific needs.

What sets us apart

· Our focus on people- our customers, partners, and coworkers

· A company culture that embraces going beyond expectations in everything we do

· A leader in providing specialty pharmaceuticals to individuals with unique conditions

· An opportunity to learn from some of the best in the business

· A diverse and inclusive culture that embraces innovation

Optime Care provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

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