Member Benefit Preservation Specialist Full Time

Job Purpose

The Benefit Preservation Specialist is responsible for program solutions in order to extend the health benefits of members, including but not limited to, patient assistant program(s) for medication coverage, pharmaceutical coupon programs and ancillary claims adjudication. The Benefit Preservation Specialist also plays a key role in helping members maximize the value of their pharmacy benefits through the coordination and management of manufacturer copay card programs, patient assistance programs, and benefit preservation strategies. This individual acts as a liaison between members, providers, and internal departments to ensure financial resources are applied accurately and efficiently to support member access to medications.

Duties and Responsibilities

• Maintain database of existing coupons and patient assistant programs
• Assess and identify appropriate program(s) for members based on needs
• Assist with enrolling members to appropriate program by gathering information from member and prescriber as needed
• Effectively communicate between the Customer Care Department and Prior Authorization personnel for seamless and efficient member service
• Ensure compliance with all applicable laws and regulations
• Continually evaluates processes and training materials for effectiveness and efficiency of the programs
• Perform QA analysis to ensure appropriate monetary values are being applied to both claim and benefit as applicable
• Develop and document policy and procedures
• Implement new plans to the program
• Term plans as they unenroll from the program
• Assist with member communication as needed when changes to plans are made (i.e. biosimilar conversions)
• Maintain and correct member deductible and maximum out of pocket accumulators as relates to coupon programs
• Assist in other duties and responsibilities as assigned

Required Skills and Abilities

• Excellent communications skills (oral, written and interpersonal)
• Analytic skills
• Pharmacy Tech certified, preferred 
• Demonstrated ability to work well in a team environment
• Demonstrated ability to provide exceptional customer service

Education and Experience

• High school diploma or equivalent
• 2+ years of experience in pharmacy benefit management, healthcare administration, or a related field.
• Knowledge of pharmacy claim adjudication processes and benefit plan design, a plus
• Familiarity with manufacturer copay and patient assistance programs, a plus.

Work environment requirements

A home office setting, free from noise and distraction allowing you to interact professionally both externally and internally and which allows appropriate maintenance of confidentiality as required by HIPAA.

Rate

Starts at $20/hour