GalaxE.Solutions · 5 hours ago

Transition of Care Analyst

United States

Full-time

Remote

Entry, Mid Level

2+ years exp

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Allan Ingraham

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Responsibilities

Utilizes resources to assist members in understanding components of the Clients products including claims, accumulators, usage, balances, and cost sharing.

Support the success of the Client and their clients through the development, presentation, and implementation of member-centric solutions that drive down the cost of specialty medications, while maintaining a positive member experience.

Support department and client requirements in the meeting of turnaround times by working as needed to ensure all referrals are handled with a focus on a timely specialty drug service solution.

Provides support in meeting client expectations regarding efficiency, service levels, privacy maintenance, and quality of decision-making.

Responsible for maintaining compliance with ERISA, HIPAA, and client specific requirements.

Work as part of the team to meet business unit objectives. Expect and accept work in an environment where change agility is fundamental to success.

Ability to deal with a diverse customer base in a friendly manner, including medical and pharmacy office providers, hospitals, members, home infusion providers and other vendors inclusive of our drug cost saving efforts.

Must display empathy and effective listening skills to deliver successful cost savings transitions of care.

The ability to balance compassion, integrity, discretion, and sound judgement, with a strong desire to achieve and exceed expected metric.

A proven background in medical/pharmacy benefits, particularly as these relate to specialty medications.

Respect work rules and procedures.

Act as an advocate for change.

Abide by all obligations under HIPAA related to Protected Health Information (PHI).

If a HIPAA violation is discovered, whether individually or by another, you must report the violation to the Compliance Officer and/or Human Resources.

Attend, complete, and demonstrate competency in all required HIPAA Training offered by the company.

Flexibility to understand, appreciate and embrace that this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities and activities may change, or new ones may be assigned at any time with or without notice.

Qualification

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Member engagementSpecialty Pharmacy experiencePBM experienceHIPAA complianceCRM platform experienceCollaboration with Clinical teamsCollaboration with sales teamsCollaboration with account managementCollaboration with senior executivesCollaboration with external clientsEffective listening skillsCompassionSound judgement

Required

2+ years’ experience with member engagement with PBM and Medical background.

2+ years’ Specialty Pharmacy or PBM experience.

2+ years’ CRM platform experience.

2+ years’ experience collaborating with Clinical, Prior Authorization, sales, account management, senior executive, and various external client facing relationships.

High School degree, some college preferred or equivalent experience.