Managed Care Coordinator - Remote

Job Description:

Overview

Maxor is currently seeking a Managed Care Coordinator to join our Specialty pharmacy team. The Managed Care Coordinator is responsible for the coordination of patient benefits in regards to their alternate care services provided by the office. Obtains the initial authorization to provide services for the patient, verifies benefits, relays benefit information to the pharmacist staff and authorizes any new medications or services provided on existing patients. Tracks patient progress and re-authorizes patient services as needed based on the original authorization that was obtained. We seek true advocates for the coordination of care. This is a remote position.

Our Company

At Maxor, we are committed to the cost-effective delivery of impactful pharmacy & healthcare services to patients & clients. Our reputation has been earned by continuously leveraging our comprehensive capabilities through innovative solutions and cutting edge technology that fuel the entire pharmacy ecosystem; delivering value to our clients & patients, both in their pharmacy spend and in positive health outcomes. Our company of 1,000 diverse people operates with transparent objectives, clear accountabilities, tenacity & passion to write the next chapter of Maxor’s long history of growth and success. But, we are more than pharmacy services. We enable pharmacy care.

Responsibilities

ESSENTIAL FUNCTIONS APPLICABLE TO ALL ROLES/DUTIES:

(This document in no way states or implies that these are the only duties to be performed by the employee occupying this position)

1. Meets performance standards and expectations.
2. Follows all Company policies and procedures.
3. Assists with projects as necessary.
4. Assists other areas as needed.
5. Assists in compiling necessary reports and/or audit information as requested.
6. Works cooperatively with other staff members to promote a positive and team oriented work environment.
7. Assists in maintaining cleanliness and orderliness of the pharmacy.
8. Participates in the Performance Improvement/Quality Management Process.
9. Maintains accurate and complete patient records.
10. Participates in pharmacy orientation programs, training programs, pharmacy staff meetings, in-services, and other programs as required.
11. Exemplifies excellence in customer communications and service.
12. Meets performance standards and expectations.
13. Has a good understanding and working knowledge of all Maxor policies and procedures, accreditation requirements and HIPAA operational guidelines.
14. May be included in after hours on-call rotation.
15. Maintains regular attendance per established policies.
16. Perform other job-related duties as assigned.

Managed Care Coordinator Functions:

1. Performs all applicable benefit investigation for each patient including:
   1. PBM
   2. Major Medical
   3. Medicaid and/or Medicare (if applicable)
2. Loads primary, secondary and tertiary insurances (if applicable) in the patient profile and to the drug order in the pharmacy system.
3. Runs test claims to determine if prior authorization is required and/or if the claim is restricted to a different specialty pharmacy.
4. Facilitates and coordinates prior authorization activities with prescriber, if applicable.
5. Follows up with the prescriber in a timely manner to facilitate prompt completion of each prior auth if the PA requires prescriber involvement.
6. Adds copay card information and any applicable patient support into the pharmacy system, if applicable.
7. Completes the order in list 3 and moves it to list 4 for RX set up.
8. Adjudicates claims on new RXs in SPRX 5.
9. Works prior authorization que daily to keep current.
10. Updates all last events as needed.
11. Enters authorization tracking information.
12. Reviews authorization tracking for prescriptions requiring re-authorization.
13. Assists with rejected claims.
14. Answer incoming calls as assigned and as transferred.
15. Responsible for the following ques in the SPRX list:

    3- Order Entry/ Completion

    4- Rx Setup

    5- Claims to Adjudicate- New Rx’s

    6- Benefits Verification- New Rx’s

    C- Claims to Adjudicate- Refills

    D- Benefits Verification- Refills

Qualifications

Education

• HS Diploma/GED required. Some college work preferred

Experience:

• Previous experience with patient accounts in a pharmacy or healthcare setting
• Understanding of insurance, prior authorization and patient benefits strongly preferred
• A minimum of one-year patient accounts experience mandatory
• Computer experience mandatory
• Ability to communicate effectively orally and in writing, to interact with a wide variety of individuals to successfully provide optimal patient care

Knowledge, Skills and Abilities

• Excellent verbal and written communications skills are a must
• Must have good mathematical skills and be able to calculate discounts and fees quickly
• Previous experience in coordinating patient care in an alternate site setting is a must
• Must be eligible for participation in all applicable State and Federal reimbursement programs. Cannot be excluded from participating in any of the programs
• Must have the ability to work well under pressure
• Must be self-motivated and be able to work without the absolute presence of a supervisor
• Must possess an analytical or problem solving thought process
• Must be confident, assertive, reliable, self-motivated, trustworthy, and sincere

WHY CHOOSE A CAREER AT MAXOR? 

Did you know that patients see their pharmacist an average of 12 times a year? Pharmacy is at the heart of healthcare. Come join Maxor and make a direct impact on patients’ lives. Improve your own wellbeing with our robust benefits and flexible work environment. At Maxor, you have a career with limitless possibilities and the charge to make a difference. A company of 1,000 diverse people and almost 100 years of pharmacy experience, we offer the stability of a Fortune 500 company with the energy and innovation of a startup. We provide services and technology that fuel the entire pharmacy ecosystem, but we are more than pharmacy services. We enable pharmacy care.

WE OFFER: A diverse, progressive culture that supports a 'dress for your day' attire and a collaborative, team oriented environment. Our industry leading compensation and health benefits include:

• Comprehensive mental health and wellbeing resources
• Nationwide Blue Cross Blue Shield PPO with employee friendly plan design, including $850 individual annual medical deductible, $25 office visit copays, Low biweekly premiums
• Company paid basic life/AD&D, Short-term and Long-term disability insurance
• Rx, dental, vision, short-term disability, and FSA
• Employer-matched 401k Plan
• Industry leading PTO plan
• And MORE!

Apply today at: https://careers-maxor.icims.com/

Maxor is an EOE, including disability/vets