Act as the primary point of contact for incoming member calls, prior authorization inquiries, and ensure appropriate escalation of cases.
Efficiently triage incoming calls with professional phone etiquette from members, prescribers, and pharmacies with minimal support.
Meet all departmental goals including schedule adherence, attendance, and quality monitoring.
Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans. They are building trust in healthcare in the U.S. and deploying infrastructure for better care.
Design and configure prior authorization criteria, decision trees, and authorization parameters within the PA system.
Perform quality assurance and quality control reviews to ensure clinical intent and regulatory compliance.
Collaborate with internal teams and external clients to support delegated PA services and system optimization.
Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans. The company is a public benefit corporation focused on rebuilding trust in healthcare in the U.S., with a culture that emphasizes collaboration and client support.
Assists with patient medication management and facilitates medication renewal requests.
Acts as a liaison between providers, patients, and pharmacies for prescriptions and prior authorizations.
Monitors prior authorization status and updates relevant parties throughout the process.
Mass General Brigham is a not-for-profit integrated health care system supporting patient care, research, teaching, and community service. They employ a diverse team of professionals including doctors, nurses, and tech experts, fostering a collaborative culture focused on exceptional care.
Interpret, evaluate, and summarize information and datasets of varying sizes.
Determine benefit limits and secure insurance approvals for specialty infusion, oral chemotherapy and high-cost medications.
Serve as a resource to patients and staff regarding insurance and drug coverage questions.
Fred Hutchinson Cancer Center is an independent, nonprofit organization providing adult cancer treatment and groundbreaking research focused on cancer and infectious diseases. Based in Seattle, it is the only NCI-designated cancer center in Washington, employing a diverse workforce that values collaboration, compassion, and innovation.
Proactively enroll patients in the Shields specialty pharmacy program through outbound calls, explaining the benefits of the service.
Review patient medical records to understand conditions and identify medications that require special handling or supplies.
Work flexible shifts within Eastern Time Zone hours, with occasional Saturday availability, and maintain confidentiality.
Shields Health Solutions provides specialty pharmacy services to health systems, helping patients access medications and support. They are a growing company focused on patient care, employee development, and a collaborative culture.
Handle inbound pharmacy calls and make outbound refill reminders to guide patients through the refill process.
Coordinate medication refills including data entry, claim adjudication, and resolving patient and provider inquiries.
Collaborate with pharmacists, clinicians, and internal teams to ensure timely and accurate patient support and process improvements.
Shields Health Solutions is a healthcare company that focuses on patient engagement and medication refill support for pharmacies. The company is large enough to offer benefits like medical, dental, and vision insurance, 401(k) match, and paid parental leave, and emphasizes a collaborative and supportive culture.
Serve as a key point of contact between patients, providers, pharmacies, and pharmacy benefit teams to coordinate alternative medication sourcing solutions.
Identify and validate appropriate sourcing options for non-covered, high-cost, specialty, or limited-distribution medications.
Assist with cost comparisons, savings analyses, reports, invoices, and documentation related to pharmacy sourcing activities.
The company helps patients navigate complex pharmacy solutions and alternative medication sourcing pathways. They are a mission-driven organization focused on patient-centered service.
Review and process prior authorizations for biologics, oncology, and specialty therapies with timely and accurate completion.
Manage clinical documentation, submit and track authorization requests, and resolve issues with insurance providers.
Communicate effectively with patients, clinical staff, and insurance representatives to ensure compliance and workflow efficiency.
IVX Health is a national provider of infusion and injection therapy for individuals managing chronic conditions like Rheumatoid Arthritis, Crohn's Disease, and Multiple Sclerosis. They are a rapidly growing company focused on patient comfort and employee empowerment, with core values of kindness, integrity, and continuous improvement.
Lead and manage a team of Patient Support Associates to ensure medication adherence, prior authorization completion, and financial assistance support.
Partner with hospital and clinic stakeholders through regular meetings and collaboration calls to ensure patients receive medications on time.
Monitor service level metrics, conduct audits, and implement process improvements to optimize workflows and drive performance.
Shields Health Solutions is a fast-growing leader in specialty pharmacy, dedicated to a patient-first culture and mission-driven care. They offer a collaborative, supportive environment with strong career growth and leadership development opportunities.
Provide expertise in prior authorization and implement the Inspire Prior Authorization Program.
Support patient intake, verify insurance, and manage prior authorization requests.
Train sites on program requirements and assist with appeals through External Medical Review.
Inspire Medical Systems is a medical device company dedicated to treating Obstructive Sleep Apnea with an innovative FDA-approved device. The company values a people-first culture, offering excellent benefits, 401k matching, and flexible time off, and is committed to diversity and patient outcomes.
Identify, research, process, and resolve customer inquiries regarding health insurance benefits, claims, and eligibility.
Analyze medical records and apply medical necessity criteria to determine the appropriateness of benefit requests.
Maintain accurate records, meet quality and timeliness standards, and coordinate with internal departments and external organizations.
Blue Cross Blue Shield of Arizona provides health insurance products and services to individuals, families, and businesses, aiming to inspire health and make it easy. The company has been recognized as a Healthiest Employer and has transformed healthcare for over 80 years with teams in Phoenix, Tucson, Chandler, and Flagstaff.
Receive and respond to prescription refill requests via phone, email, fax, and Telephone Encounter.
Verify validity and accuracy of refill requests, ensuring compliance with regulatory guidelines.
Provide exceptional customer service and collaborate with interdisciplinary teams to optimize workflow.
Carenet Health pioneers advancements in healthcare consumer experience, interacting with 1 in 3 Americans daily to improve outcomes. They foster a collaborative, innovative culture with an entrepreneurial spirit.
Manage prior authorization workflows with vendors, providers, patients, and payors.
Develop processes and training materials for offshore teams to resolve authorization issues.
Own Prior Authorization outcomes and KPIs for your region or payors.
Alpaca Health enables clinicians to become entrepreneurs, starting in autism care. We've raised over $14M in funding and are growing 30% - 50% month over month, serving thousands of patients.
Lead and manage a team of Patient Support Associates to ensure medication adherence and prior authorization support.
Proactively manage support in assigned hospitals and clinics to ensure patients receive medications on time.
Provide front-line supervision, coaching, and performance management to the Patient Support team.
Shields Health Solutions is a fast-growing company specializing in specialty pharmacy management services. They are committed to high quality and patient-centered care, with a focus on employee development and team collaboration.
Reviews Part D coverage determinations and appeals to ensure clinical appropriateness and compliance with CMS regulations.
Conducts Medication Therapy Management (MTM) activities, including comprehensive medication reviews and targeted interventions for high-risk members.
Supports pharmacy quality improvement initiatives aligned with Medicare Star Ratings and HEDIS measures.
Alignment Health is a healthcare company focused on serving seniors and the chronically ill through Medicare Advantage plans. The company is fast-growing with a team of passionate people dedicated to transforming senior care.
Review and verify insurance coverage, obtain authorizations, and create patient liability estimates while working closely with internal and external stakeholders.
Serve as a liaison between patients, providers, and insurance companies to ensure accurate financial services and resolve managed care issues.
Provide backup support and cross-coverage for the Centralized Managed Care & Price Estimates Department, including handling trauma admissions and third-party liability.
OHSU is Oregon's only public academic health center, providing patient care, leading groundbreaking research, and training the next generation of healthcare professionals. As Portland's largest employer, it offers a diverse and inclusive culture with opportunities for growth and advancement.
Grow the number of new patients filling at Shields partner pharmacies.
Lead, coach, and inspire a team of outreach coordinators.
Develop new patient engagement strategies and optimize outreach workflows.
Shields Health Solutions partners with health systems to build specialty pharmacy programs. They are a growing organization focused on operational excellence and a winning culture.