Patient Support Reimbursement Specialist

Patient Support Reimbursement Specialist

Direct message the job poster from Kelly Connect | Contact Center Solutions

The client organization is raising the bar on customer experience in the pharmaceutical industry. The Customer Service team supports eligible cancer patients and their caregivers through their CAR-T journey. They are deeply committed to providing patients/caregivers with an exceptional service experience, so they are well-positioned for treatment and to receive care.

The individual must be service-oriented and have the ability to anticipate and resolve patient/caregiver needs related to reimbursement. A successful candidate must have strong communication, critical thinking, and organizational skills, as well as the ability to multi-task and work across multiple technology platforms. The role represents a unique opportunity to assist patients/caregivers in close partnership with internal and external supplier partners.

Key responsibilities for this remote opportunity include, but are not limited to:

• Perform out-of-pocket expense reimbursement reconciliation activities that support eligible patients and their caregivers through their MyCARVYKTI journey including:
• Entering necessary patient and caregiver information and maintaining Salesforce records to continuously track progress throughout each expense submission
• Cross-checking receipts against Expense Line Items to identify any expenses that do not have a corresponding receipt submitted by the patient and caregiver
• Perform outbound calls to patients and caregivers to resolve discrepancies and request missing receipts, escalating to Patient Support Specialist if necessary
• Reviewing and organizing expense receipts submitted by patients and caregivers and recording expense information for all itemized items including non-reimbursable items in Salesforce
• Verifying final reimbursement amounts against expense limits
• Managing reimbursement escalations and appeals with PSRS Supervisor
• Completing the Reimbursement Expense Summary Report via Salesforce and emailing it to patient or caregiver following approval of the PSRS Supervisor
• Managing check requests process in partnership with ConnectiveRX
• Work collaboratively with the Patient Support Specialist (PSS) and Patient Support Eligibility Specialist (PSES) team to:
• Ability to independently manage and support patient reimbursement cases located in your territory and support teammates when needed
• Coordinate reimbursement reconciliation activities through systems to analyze and approve expenses
• Reconcile any discrepancies between Expense Line Items and submitted receipts
• Follow up and advocate until approval from PSRS Supervisor is received to secure reimbursements for patients/caregivers
• Communicate ongoing issues that arise such as inconsistent or missing information and expense receipts with respective PSS, and recommend solutions that may include requesting additional materials from patients/caregivers
• Maintain open line of communication with the PSRS Supervisor to monitor complex patient cases and expedite reimbursements that require a quick turnaround
• Serve as call center back-up to Patient Support Eligibility Specialist team in helping to conduct eligibility assessments to ensure patients meet all requirements to participate in the MyCARVYKTI Program including:
• Confirming travel benefits with the patient’s health insurance plan to avoid duplicative services to determine the program benefits that the patient and caregivers are eligible to receive
• Support/triage inbound customer calls during high volume periods by:
• Gathering relevant patient information and providing support and instructions when needed in place of PSS/PSES agents
• Assisting patients/caregivers with less complex questions/needs (i.e. reimbursement, confirmation of travel dates, etc.)
• Redirecting calls to appropriate agents or escalating cases to PSS/PSES Supervisors when needed
• Triage calls to internal Innovative Medicine stakeholders when needed
• Attend regular/ad-hoc meetings with the PSS/PSES team and leadership to summarize patient cases and discuss outstanding issues
• Participate in quality control activities and continuous reimbursement…