Patient Services Representative
Proclinical is currently recruiting for a Patient Services Representative with a biopharmaceutical company located in North Chicago, IL.
- Daily oversight and management of the patient/case representatives responsible for a variety of patient services such as assisting patients, HCPs, Nurse Ambassadors, and Field Reimbursement Specialists with new patient insurance benefits, claim rejections, answering financial alternative questions and/or document intake. Work proactively with staff and cross-functional groups to develop creative solutions to challenging patient access issues.
- Work proactively with staff and cross-functional groups to develop creative solutions to challenging patient access issues regarding prior authorization, pharmacy coordination, and denied coverage requests to ensure patient care. Monitor workflows and adjust workload and staffing requirements to ensure that all activities are addressed in a timely and efficient manner.
- Coach individuals on monitored calls and cases reviewed to ensure accuracy of information, adherence to policies and excellent customer service. Provide additional coaching and training to individuals as needed. Meet regularly with direct reports to provide direct feedback on their performance and progress against goals. Use effective coaching and management techniques to maintain a highly motivated and interactive work staff.
- Perform administrative tasks such as work hour and vacation scheduling, attendance monitoring and counseling, performance reviews.
- Meet or exceed department standards relative to metrics. Take responsibility and accountability for the day-to-day execution of tasks and is responsible for providing periodic progress on goals and metrics. Elevate and mitigate issues as appropriate.
- Consistently build and maintain collaborative relationships cross-functionally (both internal and external) to ensure a seamless customer experience for patients, HCPs and payors.
- Identify process improvements to increase operational efficiencies, develop and implement action plans for execution.
- Understand and comply with all required training, including adherence to federal, state and local pharmacy laws, patient data policies and guidelines, and the policies and procedures of both the function and company.
- Perform additional tasks, activities and projects as deemed necessary for the business by management.
Skills and Requirements:
- Bachelor's degree in health sciences or business preferred. Comparable or relevant experience will be considered.
- 3-5 years of work experience in the healthcare industry with knowledge in call center operations. Reimbursement, billing, prior authorization, appeals, and pharmacy operations experience is highly desirable.
- 1-2 years supervisor experience in a call center, large physician office/hospital system, managed care or healthcare insurance setting desired.
- Thorough understanding and knowledge of commercial and government pharmacy and medical insurance programs, billing, alternate funding resources, reimbursement processes, prior authorizations, pre-certification, appeals, pre-determination and specialty pharmacy operations.
- Proven leadership and coaching skills. Demonstrated ability to lead and participate within a team, manage multiple priorities and meet associated timelines while maintaining accuracy.
- Professional written and verbal communication skills to interact with and build and maintain relationships with all levels of the organization. Maintains a positive service image at all times even when dealing with challenging issues and unsatisfied customers.
- Proven organizational, time management and problem-solving skills, elevating to management when appropriate.
- Demonstrate strong, accurate technical skills. Detail orientated. Skilled with the use of Microsoft Office suite of products and the ability to use and effe3ctively learn and navigate other computer systems. Knowledge of Sales Force Health Cloud preferred.
- Ability to work flexible work schedule between based on business needs.
If you are having difficulty in applying or if you have any questions, please contact Zachary Hines at 215-531-6914.
ProClinical is a specialist employment agency and recruitment business, providing job opportunities within major pharmaceutical, biopharmaceutical, biotechnology and medical device companies.
Proclinical Staffing is an equal opportunity employer.