Company Name: Kroger Specialty Pharmacy
Position Type: Employee
FLSA Status: Non-Exempt

Perform duties to assist patients with access to benefits and co-pay cards, and schedule delivery of prescriptions provided through the specialty pharmacy, working within the limits of standard or accepted practice. Demonstrate the company's core values of respect, honesty, integrity, diversity, inclusion, and safety.

Essential Job Functions

• Communicate with patients to obtain information required to process prescriptions, refills, access benefits and apply charges against co-pay cards
• Investigate and verify benefits for pharmacy and medical third-party claims for assigned cases
• Obtain prior authorizations; initiate requests, track progress, and expedite responses from insurance carriers and other payers, and maintain contact with customers to keep them continuously informed
• Review for accuracy of prescribed treatment regimen prior to submission of authorization
• Facilitate appeals process between the patient, physician and insurance company; compose clinical appeals letters based off of specific denial reason and patient's clinical presentation and coordinate appointment of representative document
• Complete status check with insurance company regarding receipt/outcome of prior authorization and appeal; obtain approval information and activates copay cards based off of eligibility and specific drug prescribed
• Track, report and escalate service issues arising from requests for authorizations, financial assistance or other issues that delay service
• Notify patients when their prescription has been transferred and follow up with specialty pharmacy to confirm the prescription was received (in some jurisdictions)
• Coordinate verbal transfer by a pharmacist if specialty pharmacy has no record of prescription (in some jurisdictions); confirm with patient that prescription was received from alternate specialty pharmacy
• Complete a series of assessments mandated by either manufacturer contracts or operations and facilitates patient enrollment with manufacturer Hubs when required
• Document case activity, communications and correspondence in computer system to ensure completeness and accuracy of patient contact records
• Ensure that work activities are conducted in compliance with regulatory requirements and the organization's defined standards and procedures, and in a manner that provides the best available level of service and quality
• Perform or assist with any operations, as required to maintain workflow and to meet business needs
• Perform other related duties as assigned
• Must be able to perform the essential job functions of this position with or without reasonable accommodation

Minimum Position Qualifications

• High School Diploma or GED
• 1 year of proven work experience in a healthcare or customer service industry
• Superior telephone customer service skills
• Strong organization skills as well as attention to detail
• Excellent knowledge of insurance benefit investigation process and techniques
• Demonstrated ability to manage a range of priorities and meet time commitments
• Excellent data management software skills with demonstrated adaptability to internal systems
• Demonstrated strength in listening, oral and written communications in English

Desired Previous Experience/Education

• Pharmacy Technician Certification
• Any additional training in pharmacy/medical benefit access and requirements
• Any healthcare experience with a basic understanding of clinical terms and benefits investigation
• Any previous experience in a call center preferred where performance was measured

Education Level: High School Diploma/ GED Required
Required Certifications/Licenses: None
Position Type: Full-Time
Shift(s): [[mfield4]]
Regions: Any

States: Florida
Keywords: Patient Access Coordinator, Medical, Benefits investigations

The Little Clinic Jobs: At The Little Clinic our locations are staffed by board-certified nurse practitioners or physician assistants and patient care technicians to provide high-quality, convenient healthcare at an affordable price. The primary focus of our healthcare team is to promote health and wellness through appropriate diagnosis, treatment and patient education. The Little Clinic nurse practitioners and physician assistants are fully qualified to diagnose and treat common illnesses and minor injuries, prescribe medications, conduct tests, interpret lab results, provide wellness and preventive care, perform physical examinations and health screenings and administer vaccinations and injections. We’re growing and actively looking for qualified applicants to help us continue to provide high-quality healthcare and stellar service to our patients.

Company Overview: Kroger Family of Companies employs nearly half a million associates who serve over 11 million customers daily through a seamless shopping experience under a variety of banner names. At The Kroger Co., we are Fresh for Everyone™ and dedicated to our Purpose: To Feed the Human Spirit®. We are committed to creating #ZeroHungerZeroWaste communities by 2025. Careers with The Kroger Co. and our family of companies offer competitive wages, flexible schedules, benefits and room for advancement.

Posting Notes: FL || Lake Mary || 3200 Lake Emma Drive || 32746 || Kroger Specialty Pharmacy || None || Call Center; Patient Care; Specialty Pharmacy || Employee || Non-Exempt || Full-Time || None