Care Coordination & Copay Specialist

Department Name and ID: Pharmacy Benefit Services
Reports to: Care Coordination Supervisor & Copay Assistance Lead
Workplace Location: Remote with up to 10% travel as needed
Effective Date: 06/06/2025

Job Summary:

The Care Coordination & Copay Specialist is an essential member to the InScript team and is responsible for completing necessary functions to ensure optimal reimbursement for high-cost, take-home medications for patients receiving care. Additionally, this position will assist with medication therapy management and coordination services to ensure that plan members are obtaining their care at the lowest cost of care settings. The role will consist of supporting patients, client contact centers, pharmacies, and medical professionals. Programs typically consist of pharmaceutical brand-initiated payment assistance solutions such as co-pay cards, vouchers, financial assistance programs, and direct patient reimbursement.

Care Coordination & Copay Specialist are responsible for fielding inbound phone call requests such as copay services, pharmacy inquiries, program eligibility, and explanation of program benefits. Other areas of responsibility include completing necessary tasks to ensure optimal patient care services, such as direct patient reimbursements, program eligibility, explanation of program benefits, and attending to submission denials.

Primary Responsibilities:

• Provide initial support for customer service requests via telephone, email, fax, or any other form of contact.
• Outreach to plan members to coordinate their medication therapy management appointments.
• Facilitate transitions of care to appropriate physicians.
• Facilitate enrollment of patients in patient assistance programs and collaborate with social services and case management on patient assistance. Assist pharmacists with preparing letters of medical necessity and coordinating peer-to-peer conferences.
• Help facilitate and manage copays.
• Assess the user’s concerns and provide support accordingly in a quick and efficient manner.
• Create a positive call experience for users by showing empathy and helping them with their concerns.
• Communicate any operational challenges. Devise solutions or collaborate with management as necessary.
• Document information specific to the resolution and escalate unresolved issues expeditiously to the appropriate area.
• Facilitate adherence to medications by ensuring that patients receive prescribed medications in a timely manner.
• Make scheduled calls to patients to obtain clinical information regarding their experience with therapy and to process prescription refills. Document and triage patient problems with therapy to the appropriate pharmacist; assure documentation of problem and follow-up with patient.
• Coordinate synchronization of patients’ prescriptions.

Educational Requirement:

• GED or High School Diploma, some college preferred
• Pharmacy Technician License and experience required

Required Experience:

• Experience in medical billing, insurance verification, or similar related services
• Experience dealing with customer service and medical coordination services
• Excellent analytical skills necessary to assess and identify clinical data points, prescribing trends, and timelines.
• Self-motivated with the ability to work independently with minimal supervision.

Competencies:

• Decision-making: Ability to make decisions with significant, broad implications for the management and operations of multiple departments and institutions. Participates in decisions on the organization’s overall strategy and direction.
• Problem-Solving: Ability to address problems that are broad, complex, and abstract, often involving system-wide issues and requiring substantial creativity, resourcefulness, staff engagement, Lean diagnostic techniques, negotiation, and diplomacy to develop solutions.
• Independence of Action: Ability to set direction and vision for multiple departments or institutions. Establishes priorities, develops policies, and allocates resources.
• Written Communications: Ability to communicate complex information in English effectively in writing to all levels of staff, management, and external customers across functional areas.
• Oral Communications: Ability to verbally communicate complex concepts in English and address sensitive situations, resolve conflicts, negotiate, motivate, and persuade others.
• Knowledge: Ability to demonstrate full working knowledge of standard concepts, practices, procedures, and policies and to use them in varied situations.
• Teamwork: Ability to lead collaborative teams for larger projects or groups both internal and external to the BILH System. Results have implications for the management and operations of multiple areas of the system.
• Customer Service: Ability to provide a high level of customer service and staff training to meet customer service standards and expectations. Resolves service issues in a timely and respectful manner.

Sensory Requirements:

• Close work (paperwork, visual examination), Color vision/perception, Visual monotony, Visual clarity <3 feet, Conversation, Monitoring Equipment, Telephone, Background Noise.

Physical Requirements:

• Sedentary work: Exerting up to 10 pounds of force occasionally in carrying, lifting, pushing, and pulling objects. Sitting most of the time, with walking and standing required only occasionally. This job requires constant sitting, frequent Power Grasping using both hands, Fine Manipulation using both hands, Keyboard use. There may be occasional walking.