Patient Support Pharmacy Solutions Coordinator

Remote Work

Job Description

• Conduct thorough research on order and ticket history to recommend the best resolution that aligns with department guidelines.
• Ensure all Service Level Agreements (SLAs) are met.
• Contact relevant stakeholders to resolve issues that require cross-functional collaboration that may impact a successful patient experience.
• Build strong internal and external rapport, maintaining positive customer and partner relationships.
• Review and respond to internal escalation requests in a timely and accurate manner.
• Proactively initiate, troubleshoot, and resolve PAs and appeals via vendor portals; analyze determination trends to provide valuable insights for patient education.
• Serve as the expert liaison between prescribers, insurance payers, and partner pharmacies, translating technical hurdles into actionable solutions that ensure patient access to therapy.
• Partner closely with Customer Support to provide clear, jargon-free updates and documentation in our operating systems, ensuring the team has the patient-ready insights needed to support the patient's journey.
• Efficiently navigate multiple software systems and vendor portals with a self-starter mindset, maintaining the flexibility to prioritize tasks based on clinical urgency.
• Investigate complex claim rejections and partner with payers and pharmacies to diagnose root causes and establish and execute a clear resolution pathway that is in accordance with regulatory requirements and manufacturer business rules.
• Act as the primary technical "fixer" for orders falling outside standard workflows, resolving obstacles such as insurance exceptions, pharmacy rejections, failed transfers, and state-specific shipping regulations.

Requirements

• Licensed Pharmacy Technician in your state of residence
• Minimum 3 years of professional pharmacy technician or prior authorization experience
• Proven abilities in complex problem-solving and critical thinking.
• Highly resourceful, detail-oriented, and capable of seeing complex issues through to completion.
• Demonstrated adaptability to swift program and process changes.
• Familiarity with Zendesk, Phil Dashboard, Phil organization structure, and processes.
• Good general understanding of computers, hardware, networks, and related technology.
• Minimum 3 months of tenure with Phil (Internal Candidates).
• Consistent history of great attendance.
• Average performance scores of 95% QA.

Benefits

• Overtime (OT) and holiday work may be required.