The Coordinator, Individualized Care supports patient access to therapy through Reimbursement Support Services in accordance with the program business rules. This role is responsible for guiding the patient through the various process steps of their patient journey to therapy. These steps include patient referral intake, investigating all patient health insurance benefits, and proactively following up with various partners including the insurance payers, specialty pharmacies, support organizations, and the patient/physician to facilitate coverage and dispense of product in a timely manner. The Coordinator, Individualized mediates effective resolution for complex payer/pharmacy issues toward a positive outcome and provides a positive patient experience. This role answers inbound questions and provides customer service and technical expertise to parties.
- Maintains a current and in-depth understanding of patient therapy’s, prior approval and reimbursement processes and details of health care plans.
- Manages a queue of technical or complex therapy and reimbursement questions from customers and applies judgment in resolving service and problems falling within established limits of authority and knowledge.
- Meets key performance indicators including service levels, call volumes, adherence and quality standards.
- Follows up with patients, pharmacies, physicians and other support organizations as needed regarding inquiries.
- Handles sensitive information and personal data with discretion including prescriptions, personal information, date of birth, financials and insurance information.
- Escalates highly complex and difficult issues as needed to senior team members and Individualize Care leadership.
- 1-3 years of experience, preferred
- Minimum high school diploma or GED; preferred
- Basic computer knowledge, Microsoft systems
- Strong communication/customer service skills
- Ability to be an independent worker and self-directed
- Ability to sit for long periods of time in a cubicle setting
- Demonstrate superior customer support talents
- Ability to prioritize multiple, concurrent assignments and work with a sense of urgency
- Knowledge of Medicare, Medicaid and Commercially insured payer common practices and policies, preferred
What is expected of you and others at this level
- Applies acquired job skills and company policies and procedures to complete standard tasks
- Works on routine assignments that require basic problem resolution
- Refers to policies and past practices for guidance
- Receives general direction on standard work; receives detailed instruction on new assignments
- Consults with supervisor or senior peers on complex and unusual problems