About the position
Help patients receive important therapy without unnecessary delays. In this role, you will use your knowledge of insurance, reimbursement, payer requirements, and pharmacy operations to clear patient accounts for medication shipment. You will partner with internal teams, payers, providers, pharmacies, and manufacturer contacts to remove barriers, support timely treatment, and improve the patient experience.
Responsibilities
• Review patient accounts, insurance requirements, authorization status, and coverage details to determine shipment readiness.
• Identify and resolve barriers that may prevent medication shipment, including claim rejections, reimbursement issues, benefit concerns, and payer requirements.
• Coordinate the activities needed to clear patients for shipment, including benefit review, claim resolution, authorization validation, and payer requirement review.
• Research coverage and reimbursement challenges and use sound judgment to determine next steps, escalation needs, and resolution plans.
• Partner with pharmacy operations, patient access teams, healthcare providers, payers, manufacturers, and internal stakeholders to support timely shipment outcomes.
• Escalate high-risk shipment barriers that could cause therapy interruption, delayed treatment, patient dissatisfaction, or financial impact.
• Communicate shipment status, issue resolution, and trends clearly and professionally to business partners and external contacts.
• Serve as a subject matter resource for complex shipment clearance questions, insurance requirements, and patient access barriers.
• Support process improvements, training, best-practice sharing, and special projects that improve shipment clearance and patient access outcomes.
Requirements
• Must be able to work Monday - Friday 11:00AM - 8:00PM EST
• High school diploma or GED.
• Minimum of 3 years of experience in healthcare, specialty pharmacy, patient access, insurance verification, reimbursement, revenue cycle management, or a related field.
• Knowledge of medical or pharmacy insurance benefits, authorization requirements, payer requirements, claims, and reimbursement processes.
• Strong problem-solving and analytical skills, with the ability to research complex issues and identify practical solutions.
• Excellent verbal and written communication skills with the ability to work professionally with internal and external partners.
• Ability to manage multiple priorities in a fast-paced environment while maintaining accuracy, follow-through, and attention to detail.
• Ability to work independently, use sound judgment, and collaborate across teams to resolve shipment barriers.
Nice-to-haves
• Associate or bachelor's degree.
• Experience in specialty pharmacy, advanced therapy, patient access, or shipment clearance operations.
• Experience resolving claim rejections, coverage issues, reimbursement barriers, or payer-related shipment delays.
• Experience working with healthcare providers, payer organizations, manufacturer contacts, pharmacy operations, or cross-functional business partners.
• Knowledge of Express Scripts, Evernorth, or related pharmacy systems, products, and services.
• Experience supporting process improvement, training, workflow enhancements, or operational projects.
Benefits
• Medical insurance
• Vision insurance
• Dental insurance
• Well-being and behavioral health programs
• 401(k)
• Company paid life insurance
• Tuition reimbursement
• A minimum of 18 days of paid time off per year
• Paid holidays
• Leaves of absence