Managed Care Coordinator

  • Maxor National Pharmacy Services Company
  • Amarillo, TX, US
  • Oct 16, 2020

Job Description

Overview

Maxor Specialty is currently seeking a Managed Care Coordinator to join our dynamic team in Amarillo. 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.

Our Company

At Maxor, we're transforming the pharmacy industry to create healthier lives through purposeful engagement across Pharmacy Benefit Management, Pharmacy Management, Specialty Pharmacy, 340B, Rebate and Formulary Management, and Pharmacies. We put people first and are committed to providing outstanding service across all aspects of our business. Our goal is to create flexible and innovative solutions filled with inspired possibilities.

Locations

The Maxor team brings robust experience, diverse perspectives and passion from a nationwide team of 900+ professionals located in more than half of the US states.

Responsibilities

  • Responsible for all case management duties for Maxor Specialty patients including initial authorization, price negotiation, updates and extensions with insurance, Hospital case managers, employers, physicians and other sources required to coordinate the patient financial services.
  • Works directly and indirectly with case managers, hospital discharge planners, physicians and other referral sources to coordinate clinically appropriate, cost effective services for patients.
  • Responsible for evaluating guidelines to ensure the therapy is approved for the diagnosis.
  • Acts as a resource for any and all subcontracted providers.
  • Maintains a good working knowledge for all payor and provider contracts.
  • Responsible for relaying important patient insurance and/or payor information to the pharmacist staff for future dispensing.
  • Thoroughly reviews all the following for accuracy and up to date info before quoting any type of pricing to third party payors or case managers; compare current AWP through Amerisource Bergen with AWP in CPR+, compare contracted fee schedule with cost in CPR+ to ensure a positive gross margin.
  • Secure needed medical documentation required or requested by third party insurance.
  • Assist pharmacy staff with RX card rejections and submits for PA or cost overrides.
  • Scans Insurance verification forms and other necessary documentation.
  • Demonstrate knowledge of and supports policies and procedures, operating instructions, confidentiality standards, and the code of ethical behavior.
  • Completes other miscellaneous duties as assigned.
  • Maintains good inter/intra departmental relationships. Works to create an amiable atmosphere within the department and company.
  • Responds to change, performance improvement support, professional growth, and meet development goals.
  • Maintain regular attendance in accordance with established policies.
  • Promptly report any allegations of impropriety to the Compliance Department.
  • Comply with Maxor's Ethical Business Conduct policy and Maxor's Compliance Program.
  • Remain free from exclusion under the OIG and SAMS Medicare/Medicaid lists.
  • Complete required training, as assigned, within the established timeframes.
  • Must be able to cope with the mental and emotional stress of the position.

Requirements

Work Schedule

  • This is a full-time, Monday-Friday, 8am-5pm position

Education

  • HS Diploma/GED required / Some college work preferred
  • Pharmacy Technician License required

Experience:

  • Previous experience with patient accounts in an alternate 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 posses an analytical or problem solving thought process.
  • Must be confident, assertive, reliable, self-motivated, trustworthy, and sincere.

Why Choose Maxor?

As a division of Maxor National Pharmacy Services LLC., IVSolutions offers a culture that promotes teamwork and where employees are valued as the Company's best asset. We work hard, but we make sure to have fun along the way, too. Competitive salary plus a great benefits package are available including:

  • $750 individual, annual medical deductible
  • $25 office visit copays
  • Low biweekly premiums
  • Company paid basic life/AD&D and Long-term disability insurance
  • Rx, dental, vision, short-term disability, and FSA
  • Employer-matched 401k Plan
  • And more!

For immediate consideration please apply at https://www.maxor.com/about/careers

Maxor is an EEO/AA/M/F/Vets/Disability

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities