Express Scripts Patient Access Representative III - Accredo in Warrendale, Pennsylvania

Schedule: Full-time
Job ID: REQ20004935

POSITION SUMMARY

The Patient Access Representative III performs specialized patient access functions requiring an advanced understanding of insurance benefits and internal processes in order to successfully liaise with Payers, Pharma, Physicians and Patients. This role directly interfaces with external clients and requires a high level of independent judgment in order to establish and maintain effective relationships with clients to gain their trust and support. Relies on experience and knowledge of industry best practices to identify exposures to the company and facilitates leadership’s knowledge of pending referrals that may have an adverse impact on company goals and the patient experience. Acts as a liaison between both internal and external resources to reduce client abrasion, facilitate the timely processing of referrals and provide accurate status reporting to clients.

ESSENTIAL FUNCTIONS

  • Facilitates cross-functional resolution of drug coverage issues & proactively address, researches & resolves issues impacting revenue optimization.

  • Performs medical /pharmacy benefit verification requiring complex decision skills based on payer and process knowledge resulting in on boarding or no starting a specialty patients.

  • Contacts benefit providers to gather policy benefits/limitations; coordinating and ensuring services provided will be reimbursable (e.g., deductible amounts, co-payments, effective date, levels of care, authorization, etc.). Directly interfaces with external clients.

  • Performs medical /pharmacy benefit verification requiring complex decision skills based on payer and process knowledge resulting in on boarding or no starting a specialty patients.

  • Provide expert assistance to clients on patient status. Liaison for company providing referral status reporting.

  • May negotiate pricing for non-contracted payers and authorize patient services and ensure proper pricing is indicated in RxHome. Handle Escalations. Use discretion & independent judgement in handling pt or more complex client complaints, escalating as appropriate.

  • Completes other projects and additional duties as assigned

QUALIFICATIONS

  • High school diploma or GED required, bachelor’s degree preferred

  • 3-5 years of relevant working experience; Health care experience with medical insurance knowledge and terminology and experience in patient access preferred

  • Intermediate data entry skills and working knowledge of Microsoft Office, Patient Access knowledge

  • Extensive knowledge of ESI products and services a must; Experience training and coaching less experienced staff with patience to explain details and processes repeatedly; Excellent phone presentation and communication skills; Demonstrated ability to handle challenging customers in a professional manner; Ability to adapt in a dynamic work environment and make decisions with minimal supervision; Advanced problem solving skills and the ability to work collaboratively with other departments to resolve issues with innovative solutions

ABOUT THE DEPARTMENT

A leading provider of specialty pharmacy services, Accredo improves care for patients through behavioral and clinical expertise.

Accredo offers a broad range of healthcare products and services for individuals with chronic health conditions, such as growth hormone deficiencies, hepatitis C, hemophilia, oncology, multiple sclerosis and rheumatoid arthritis. It also provides comprehensive patient management services, including clinical care management programs, counseling, education, outcomes measurement, social services and reimbursement services.

ABOUT EXPRESS SCRIPTS

Advance your career with the company that makes it easier for people to choose better health.

Express Scripts is a leading healthcare company serving tens of millions of consumers. We are looking for individuals who are passionate, creative and committed to creating systems and service solutions that promote better health outcomes.

Join the company that Fortune magazine ranked as one of the 'Most Admired Companies' in the pharmacy category. Then, use your intelligence, creativity, integrity and hard work to help us enhance our products and services.

We offer a highly competitive base salary and a comprehensive benefits program, including medical, prescription drug, dental, vision, 401(k) with company match, life insurance, paid time off, tuition assistance and an employee stock purchase plan.

Express Scripts is committed to hiring and retaining a diverse workforce. We are an Equal Opportunity Employer, making decisions without regard to race, color, religion, sex, national origin, age, veteran status, disability, or any other protected class. Applicants must be able to pass a drug test and background investigation.

Express Scripts is a VEVRAA Federal Contractor.