Patient Access Liaison; PAL

Overview

Bio Matrix is a nationwide, independently-owned infusion pharmacy with decades of experience supporting patients on specialty medication. Our compassionate care team helps patients navigate the often-challenging healthcare environment. We treat our patients like family and get them started on therapy quickly. We work closely with them as well as their family and their healthcare providers throughout the patient journey, staying focused on optimal clinical outcomes.

As a key member of the Intake team, a Patient Access Liaison (PAL)- Active will be responsible for ongoing monthly eligibility monitoring of Active patients. If/when change of insurance or benefits is identified, PAL
- Active will work with patient, sales, and/or physician to obtain new insurance and/or supporting clinical documentation to secure authorization. PAL
- Active will advise the Reimbursement Specialists of new insurance and the need for new benefits verification and prior authorization if applicable. PAL
- Active will continue to be the point of contact with patients, sales, physician to provide updates as necessary and may also assist with authorization and benefits questions from patients as they arise.

A PAL
- Active will be aligned to specific teams and will be responsible for monitoring coverage for that set of patients. This role will work closely with data entry, reimbursement, nurse coordination, and pharmacy operations team members supporting various stages of the intake and pharmacy management processes and will understand the case status and next steps for each referral they are responsible for supporting.

Location:

Position on site Overland Park, KS or Garnet Valley, PA

Schedule:

8:30 am-5:00 pm CST or EST

• 1-3 years of experience managing patient referral and prescription activities or reimbursement services in infusion or specialty therapies
• 1-3 years of experience providing customer service in health care setting (patients and/or providers), including meeting high quality standards for services and evaluation of customer satisfaction
• Electronic health medical record or pharmacy patient management experience
• High School Diploma or equivalent, Bachelor's Degree preferred
• Ability to multitask in a fast-paced environment
• Proficient in medical or pharmacy terminology, written or verbal
• Moderate skills in Microsoft Office (including Word, Excel, PowerPoint, etc.)
• Willing to travel up to 5% of the time for business purposes (when necessary to attend meetings, conferences, seminars, etc.)

• 1-3 years of experience in supporting prescriber, healthcare setting, patient, and field facing communications related to referral or prescription services in infusion or specialty therapies
• General understanding of prescription benefits, insurance/payer requirements, and verification processes
• General experience working in a health care setting or services environment
• General knowledge of infusion therapy process and patient needs

• Monitor Care Tend queues for Active patients and review eligibility monthly. Ensure authorization is on file and there are no barriers to servicing a patient before Pharmacy team contacts patient to set up delivery.
• If any insurance coverage issues are identified, PAL
  - Active will work with patient, sales representative and Physician to obtain any necessary information for further review to overcome the barrier.
• Assist with PAL-Pending duties as needed for coverage or additional support
• Ensure last events are accurate and cases are progressing as expected
• Perform activities timely and ensure downstream teams are aware of any potential service delays
• Work closely with Reimbursement Specialists and conveys outcomes of benefit investigation activities with patient when it comes to patient out of pocket costs, financial responsibility, and financial assistance options for patient support consideration
• Work closely and communicate with Nurse Coordination team for those patients who intend to move forward with service and require in-home nurse care to be scheduled and organized around prescription fulfillment and shipping
• Work closely and communicate with Pharmacy operations team members ensuring clinical and fulfillment resources have everything they need to successfully support the on- boarding and on-going fulfillment for a new patient referral/prescription
• Produce written documentation representing all provider, patient, caregiver, and/or field team updates and communications in necessary systems of record
• Understand referral process, volume, and workload metrics and goals established by leadership; use goals to effectively organize referral workload and daily activities for successful outreach and completion of referral steps needed to attain service outcomes/determination
• Support use of technology and other innovative digital channels for internal and external stakeholder communication as directed by leadership; leverage professional and effective communication…