About this role
Job Summary:
The primary role and responsibility of the Account Specialist is to service our manufacturing partners, or “the client”, by interacting with our client-specific access managers via regular phone calls, virtual meetings, and email communications to ensure alignment and follow through on patient accounts. The Account Specialist will need to be a subject matter expert in their region as well as nationwide coverage and policy requirements by monitoring any changes in payer policy/landscape. Strong communication skills will be required to ensure a positive working relationship with all customers. The below is intended to describe the general content of and requirements for the performance of this job and is not to be construed as an exhaustive statement of essential functions, responsibilities, or requirements.
Primary Duties and Responsibilities
1.Provide information to and collaborate with client partners, to assist physicians and patients in obtaining appropriate access to their medication.
2.Subject matter expert on reimbursement processes such as benefit verification, formulary reviews, prior authorization, appeals.
3.When required, able to communicate and interact with government and commercial payers to identify (i) availability of drug coverage; (ii) patient eligibility for coverage; (iii) prior authorization requirements; (iv) coordination of benefits and primary and secondary coverages; and (v) plan limitations (i.e., maximum quantity per order, refill too-soon, timely filing), and accurately communicate the same to client partners.
4.When required, able to address claim rejections/denials, identifying reasons for rejections.
5.Strong understanding of patient-support programs and working in partnership with internal teams within the program and company.
6.Establish and maintain knowledge of local and national payer landscape.
7.Answer questions, identify issues and conduct follow-up as needed with accounts.
8.Effectively and timely completes reports and special projects as requested by HUB services management.
9.Establish, develop, and maintain strong working relationships with all customers.
10.Regular and reliable attendance expected.
11.Other work-related duties as assigned by supervisor/manager.
Minimum Knowledge, Abilities, and Skills Required
1.Minimum High School Diploma required, Bachelor’s degree preferred.
2.Minimum of 4 years of prior experience in specialty pharmacy reimbursement, billing, specialty pharmacy benefits investigations, or manufacturer HUB services.
3.Strong knowledge base in healthcare policy and reimbursement for all payer types including Commercial, Medicaid and Medicare.
4.Proficient working with Microsoft Office including but not limited to Outlook, Excel, Word, Power Point, Visio, etc.
5.Experience with relationship building with customers, time management skills, critical thinking, and task prioritization.
6.Must possess a good understanding of Medicaid, Medicare, and Commercial Health Plans.
7.Excellent communication and relationship skills are required.
8.Ability to communicate effectively orally and in writing.
9.Must be able to work independently as needed.
This description is intended to be only a general outline of major activities. It is expected that the employee performs these and any other activities which may be assigned, or which may occur in the normal course of work. This description is not a contract or guarantee of employment. AnovoRx is an Equal Opportunity Employer.
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