Job Description

Scope of Responsibilities: Provide guidance, assistance and expertise regarding specialty assistance programs between ProAct and contract pharmacies to include Noble Health Services and other specialty and/or retail pharmacies. Coordinate with all appropriate parties to secure funding assistance, medication shipment and regularly communicate updates on member-specific cases. Works under direct supervision and follows standard procedures to accomplish assigned tasks.

Responsible for coordinating functions related to specialty assistance programs to include, but not limited to ProActPLUS and other external copay sourcing program related operations on a day-to-day basis. Act as the liaison between ProAct, and Noble Health Services (or other network pharmacies) to support these programs and its components.

Responsibilities

Job Duties:

• Support ProAct clients and members regarding functions related to specialty assistance programs.
• Partner with Noble Health Services and other network pharmacies on the administration of ProAct-owned programs such as ProActPLUS as well as third party solutions and other utilization management programs.
• Perform outreach to physician offices and members to request prescriptions, confirm assistance components, etc.
• Process overrides in ProAct’s processing database to ensure claims are processing as intended after funding is secured.
• Assist Noble and other network pharmacies with various other ProAct-related inquiries or overrides that need to be entered for successful claim processing.
• Complete all mandatory KPH, state, and federal training programs.
• Perform other duties as assigned.

Qualifications

Experience Preferred:

• Preferred: 2 Years experience with Health Care, Insurance and/or Project Management

Special Conditions of Employment:

• Drug test
• Initial and continuous exclusion and sanction/disciplinary monitoring
• Any and all additional eligibility requirements based on the specific position

Required Training:

• HIPPA Privacy Course and CE Mastery Exam
• HIPPA Security Course and CE Mastery Exam

Job Requirements:

• Successful completion of a pre-employment and/or random drug screening test

Job Skills Required:

• Strong Communication Skills, must be able to effectively communicate both on the phone and in email setting
• Strong PC Skills, will be using multiple different PC programs
• Must be able to work independently

Behavioral Traits Required:

• Customer Service: Must provide timely and accurate responses to all business associates and customers
• Organization: Must organize work in a systematic way, establish clear lines of responsibility, and delegate effectively
• Communication: Must write and speak clearly and effectively at all levels, listen and be attentive to others
• Technology: Must use technology to its fullest potential to achieve department and corporate goals
• Flexibility: Ability to adapt to changing business needs. To balance multiple priorities and deliver under pressure