Patient Navigator

The Patient Navigator role involves building trusted relationships with patients and providing personalized case management to support their healthcare journey. The role focuses on helping patients navigate their healthcare options and ensuring they receive the necessary support and resources. In this role, patient navigators will advise patients on their insurance coverage options and potential copayments, prior authorizations, and formulary restrictions. They will help patients understand their insurance plans and their options to acquire medications. Patient navigators will additionally offer patient assistance, when requested, in locating healthcare providers that align with their individualized insurance plan requirements.

As a Patient Navigator, your responsibilities will include, but are not limited to, the following:

Relationship Management:
Build and maintain trusted relationships with patients by demonstrating proactive communication, delivering timely and accurate services, and showing a strong commitment to patient well-being.
Ensure all interactions and relationship management practices comply with relevant healthcare laws and regulations.
Demonstrate prior experience working with pharmacy benefit products and patients, or in immunology practices, to better understand patient needs and concerns.
Communications:
Conduct program welcome calls to patients, engaging them effectively and explaining available services and resources for their support.
Utilize motivational interviewing techniques to actively involve patients in goal setting and achieving their healthcare objectives.
Perform post Benefits Investigation calls to patients, clearly explaining coverage options to enhance patient understanding.
Effectively handle all client inquiries that cannot be resolved through standard reporting processes.
Address patient inquiries in accordance with applicable business rules, providing accurate and helpful information.
Articulate complex reimbursement and billing information in a clear and concise manner to ensure patients comprehend their coverage benefits and financial responsibilities.
Inbound Call Management:
Handle inbound calls as per the program-approved Frequently Asked Questions (FAQs).
Exhibit excellent customer service skills, even in a fast-paced environment, and de-escalate any challenging situations in a professional and appropriate manner.
Triage patients to appropriate internal or external resources, depending on their needs and requirements.
Ensure proper documentation and recording of patient enrollment into the program, following established business rules.
Personalized Case Management:
Provide patients with comprehensive information and education about products, including the course of treatment, insurance coverage benefits, anticipated out-of-pocket costs, potential financial assistance resources, and ongoing treatment support.
Proactively manage assigned cases and tasks to maintain service levels and deliver excellent customer service to patients.
Empower and inspire patients to take charge of their therapy plan as prescribed by their healthcare provider.
Leverage electronic tools to identify benefits and payer coverage, conducting manual benefit investigations when necessary.
Identify and communicate patients' plan benefit coverage, including any prior authorization, appeal, tier exception, or formulary exclusion requirements.
Utilize electronic resources to obtain benefit coverage outcomes, and if needed, conduct outbound calls to payers and healthcare providers for follow-up.
Support adherence services through the coordination of nurse follow-up, as applicable to the program.
Identify and recommend peer support resources for patients to enhance their treatment experience.
Coordinate the shipment of products through patient assistance programs and/or bridge programs from the PharmaCord pharmacy.
Proactively communicate the need for re-verification of prior authorization or re-enrollment for patient assistance programs.
Report adverse events, product complaints, special situation reports, and medical inquiries in accordance with established SOPs and Business Rules.
Document all activities within the PharmaCord Lynk system to maintain accurate and up-to-date records, adhering to business requirements.
Requirements:
Bachelor's degree strongly preferred or equivalent experience required; completion of a high school diploma or GED is required
Customer service and healthcare industry experience strongly preferred
Ability to work an 8.5-hour shift between 8 am to 11 pm, Monday to Friday required
Bi-lingual in English and Spanish or Chinese/Mandarin is a plus
All employees working onsite in a PharmaCord facility are strongly encouraged to be vaccinated against COVID-19
We are located in the River Ridge Commerce Center at 150 Hilton Drive, Jeffersonville, IN. You must be willing to work in this location; PharmaCord does reimburse for tolls if applicable, at the frequent user rate. This rate is applied after 40 trips per month (valued at $655.20 per year).
Successful candidates possess the following personal attributes:
Commitment to the mission of care coordination
Passionate, trustworthy, and empathetic when working with patients.
Good communication and interpersonal skills and ability to speak concisely to patients
Flexible and adaptable in response to changing patient and healthcare providers' needs
Professional telephone etiquette
Self-awareness of your own emotions and the potential impact on others
Basic computer knowledge
Ability to multitask effectively
Ability to recognize emotions and their effects
Sureness about self-worth and capabilities
Manage disruptive impulses
Maintain standards of honesty and integrity
Takes responsibility for performance
Adapts and handles change with flexibility
Is innovative and open to new ideas
Achievement driven; constantly striving to improve or to meet a standard of excellence
Aligns with the goals of the group or organization
Ready to take initiative and act on opportunities
Be optimistic and pursue goals persistently despite obstacles and setbacks
Be service oriented and anticipate, recognize and meet the needs of others, including patients and care partners
Positive attitude.
Physical Demands & Work Environment:
This is an office-based position, the ability to sit for extended periods of time is necessary
While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to sit for long periods of time, use hands to type, handle or feel; and reach with hands and arms. Must be able to type 35 WPM with 97% accuracy.
Although very minimal, flexibility to travel as needed is preferred.
This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, etc.
This position requires ability to work a standard 8.5-hour standard shifts between our business operating hours of 8am - 11pm Monday through Friday. A shift will be assigned and may change depending on business need.
Due to investment in program specific training, candidates are expected to maintain role for a minimum of 6 months, or within a client-facing role, prior to being considered eligible for lateral or promotion level move. PharmaCord is committed to creating a strong company culture that values collaboration, employee development, and promotion from within. Exceptions will be reviewed on a case-by-case basis to assess business need and service impact.
Once you land this position, you'll get to enjoy:
Our Benefits & Perks
Company paid Short-term Disability (STD)
Increased competitive 401(k) company match up to 4%
Affordable Medical, Dental, and Vision benefits - PharmaCord covers 75% of Medical Premiums for our employees
PharmaCord has not increased healthcare premiums in the past 4 years
Concierge Medical Clinic free of cost for those enrolled in a PharmaCord medical plan (including dependents)
Wellness discounts of up to $260 per year for participation in wellness program
Annual HSA employer contribution
Company paid and voluntary Life Insurance options
Voluntary Life, AD&D and Long-Term Disability Insurances
Paid Parental Leave of Absence
Wellness and Employee Assistance Programs
PTO benefits, flex days and paid holidays
Employee Referral Program
Ambassador Program
Tuition reimbursement program up to $5,000 per year
Competitive Compensation & Flexible Working
Competitive starting pay rates
Yearly merit increases
Toll reimbursement program (valued at $655.20 per year)
This role may be eligible for a hybrid schedule (50% in office, 50% remote). To qualify for a hybrid schedule, you are required to work a minimum of 6 months on-site at our headquarters location. You must show you've successfully completed training, are in good performance and attendance standing, and are consistently meeting KPI's as outlined within the program business rules.
Multiple shift options between 8 AM and 11 PM Monday - Friday
A Career You'll Love
Working for PharmaCord - voted Best Places to Work in Kentucky for 2019 and 2021
Work for a company that values diversity and makes deliberate efforts to create in inclusive workplace
Opportunities for advancement with a company that supports personal and professional growth
A challenging, stimulating work environment that encourages new ideas
Exposure to many learning and development opportunities
Playing a crucial part in the lives of our patients, physicians, and pharmacies by enhancing the patient services experience . click apply for full job details