Intake Representative

River's Edge Pharmacy

River's Edge Pharmacy has become a leader in infusion therapy services. Administered by specially trained infusion nurses, these services are provided at standalone locations, physicians' offices. Each location provides individualized care in a private setting for procedures including IVIG, Hemophilia, Chemotherapy, TPN, and Pain Management. River's Edge Pharmacy started in Rancho Mirage, CA in 2008 to address the need for compassionate care by specialty pharmacies. In 2013, the Company moved to a larger facility in Palm Desert, CA. The successful execution of River's Edge Pharmacy's growth strategy led to the opening of a total of nine infusion locations and two pharmacies in California. Since the expansion, River's Edge Pharmacy has become the specialty pharmacy and infusion service provider of choice for patients and physicians seeking exceptional expertise, human kindness, and professional guidance. The team of pharmacists, technicians, and care experts at River's Edge Pharmacy serve as patient advocates by combining professional expertise with caring support. These services are all part of River's Edge Pharmacy's commitment to helping patients live better lives while navigating the complicated world of medicine and health insurance.

Intake Representative

Perform duties related to the processing of new referrals and refill specialty prescriptions. They will be responsible for fostering the relationship between doctors, patients, insurance, and the pharmacy. They will have a working knowledge of the specialty prescription life cycle and the intake team's role in the cycle.

Primary Responsibilities:

1. Obtain refill authorizations and check status of pre authorizations with PA team. Complete patient registration for new prescriptions. Obtain additional information to complete registration. Review patient information for accuracy and changes on refill prescriptions. Participate in patient care coordination. Verify prescription with insurance, doctor, and patient. Communicate with patients regarding coverage and financial obligations. Proactively aide with copay assistance programs and applications. Follow protocol for zero refill prescriptions. Maintain company standard on turnaround time per prescription. Escalate delays and concerns to Intake Supervisor

Team Specific Accountabilities:

• Communicate with patients to obtain information required to process prescriptions, refills, access benefits and apply charges against co-pay cards, and build trusted and enduring customer relationships that yield loyalty.
• Investigate and verify benefits for pharmacy and medical third party claims for assigned cases. May communicate with financial assistance team of drug manufacturers to apply for and secure financial assistance for patient when assigned.
• Follow up with Pre-Authorization team to provide additionally required information, track progress, and maintain contact with customers to keep them continuously informed.
• Facilitate appeals process between the patient, physician, and insurance company by requesting denial information.
• Compose clinical appeal letters based on specific denial reason and patient's clinical presentation. Ensure all clinical information and documentation are obtained prior to appeal submission. Coordinate appointment of representative document with patient and physician office.
• Complete status check with insurance company regarding appeal and approval or denial status. Obtain approval information and activate copay cards based on eligibility and specific drug prescribed.
• Track, report, and escalate service issues arising from requests for authorizations, financial assistance or other issues that delay service, to ensure patient access and to avoid delays that may interrupt therapy.
• Build and maintain effective business relationships with prescribers treating assigned set of disease states and provide ongoing communication of specific case-related information as appropriate.
• Complete a series of assessments mandated by either manufacturer contracts or operations. Facilitate patient enrollment with manufacturer hubs when required.
• Review notifications of patients in need of financial assistance to cover the cost of their prescriptions. Communicate with patients to provide information regarding assistance programs and community resources that provide the required assistance.
• Obtain required information and permission from patients and submit electronic applications for financial assistance on their behalf, or provide patients with forms required by assistance providers. Follow up with patients and assistance providers on status of claim to avoid interruption in therapy.
• Update all unfilled prescription activity status in the software every 48 hours.
• Ensure that work activities comply with the organization's defined standards and procedures, and in a manner that provides the best available level of service and quality.

Plus may perform other duties as assigned.

Education:

• High school diploma or equivalent required
• Associate or Bachelor's degree in healthcare, life sciences, or business preferred
• CA BOP Pharmacy Technician License preferred

Experience:

• 1 or more years prior Pharmacy or experience.
• 1 or more years prior experience with Specialty or Infusion Pharmacy medications.

Technical / Specialized Knowledge, Skills Abilities:

• Thorough knowledge of Specialty Pharmacy laws and regulations.
• Proficient with Microsoft Office Suite or related software.
• Excellent verbal and written communication skills.
• Excellent interpersonal, negotiation, and conflict resolution skills.
• Excellent organizational skills and attention to detail.
• Strong analytical and problem-solving skills.
• Ability to prioritize tasks and to delegate them when appropriate.
• Ability to act with integrity, professionalism, and confidentiality.

Working Conditions:

• This is a full-time position in a professional office environment.
• The role requires prolonged periods of sitting, frequent use of a computer and other standard office equipment, and occasional lifting of up to 20 pounds.
• Regular attendance and punctuality are essential. Some evening or weekend work may be required based on business needs.

Equal Opportunity Employer:

We are an equal opportunity employer committed to diversity and inclusion. We celebrate diversity and are dedicated to fostering an inclusive environment for all employees.