Role Description

The Patient Services Specialist III is responsible for initiating, researching, completing, submitting, and tracking Patient Services Program applications for assigned facilities. This role requires proactive interaction with facility staff, patients, payers, and patient assistance programs (PAP).

• Conduct benefit verification and complete necessary third-party prior authorizations, reimbursement activities, patient assistance, and copay program enrollments.
• Perform patient onboarding, benefit verification, prior authorization, financial assistance, and appeals processes on behalf of patients and their physician.
• Provide new-hire training, training support for transitioning team members, and cross-training for the team.
• Interact with patients and providers to obtain insurance benefits and patient information needed to request prior authorizations.
• Ensure that patient-specific reimbursement related information is obtained and available for review.
• Obtain appropriate signatures and documentation for completed PAP applications prior to submission.
• Complete patient adherence activities including notification of upcoming refills and coordination of prescription delivery.
• Provide temporary coverage to support clients and patients in the event of onsite resource absences.
• Work within health system’s electronic medical record system and other applicable systems to support workflow management.
• Provide integrated services to increase prescription capture rate and improve patient outcomes.
• Resolve barriers proactively that may affect reimbursement at assigned facilities.
• Establish business relationships with assigned clinic staff, pharmacy, and hospital contacts.
• Assist on special projects within job scope to optimize profitability when requested by management.
• Communicate patient and provider feedback to management to enhance process improvement.

Qualifications

• Broad training in fields such as Medical Office Administration, Social Work, Medical Records/Billing, Benefit Verification, Patient Financial Services, Pharmacy, Nursing, or similar vocations.
• Completion of a 2-year Associate Degree, technical vocational training, or equivalent combination of experience and education.
• Bachelor's degree program preferred.
• 3+ years of directly related or relevant experience.
• Minimum of one (1) year experience as a Patient Services Specialist I.
• Pharmacy Technician Certification Board (PTCB) certification is required.

Requirements

• Ability to communicate effectively both orally and in writing.
• Strong organizational skills; attention to detail.
• Ability to work quickly and accurately under time and volume constraints.
• Ability to be proactive and tenaciously seek solutions under minimum supervision.
• Demonstrated competence in Microsoft Excel, Word, and Visio.
• Strong analytical skills.
• Strong interpersonal skills.
• Familiarity with insurance/claims processing, pharmaceutical products, services, software, and drug interactions.

Benefits

• Comprehensive medical, dental, and vision care.
• Support for working families, including backup dependent care, adoption assistance, and infertility coverage.
• Behavioral health solutions, paid parental leave, and paid caregiver leave.
• Variety of training programs and professional development resources.
• Opportunities to participate in mentorship programs, employee resource groups, and volunteer activities.