Job Title: Hub Access Specialist II
Cycle Company: Cycle Pharmaceuticals, Inc
Location: Virtual, West Coast. With the current COVID-19 travel restrictions and lockdowns in certain areas of the country, we may require you to work from home for all or part of the week.
Position Summary: The Cycle Pharmaceuticals Access Specialist is responsible for timely, accurate and complete insurance verification and prior authorization, including appeals support. This role is customer facing to both Health Care Professionals and Patients, responsible for the creation and delivery of benefits summaries via written and verbal means. Using the benefits summary and program guidelines, the Access Specialist appropriately and compliantly offers the correct financial assistance programs including free drug offerings and the Cycle Pharma Copay Program. The position will also refer appropriate Patients to additional service offerings including Patient Education & Support and Nursing Services. The role requires intense phone and screen time calling on a multitude of stakeholders, logging calls and documenting outcomes in Cycle Pharma’s Customer Relationship Management platform (CRM) and end to end case management service. Including: field-based responsibilities defined as visiting offices to advise on the reimbursement process, reimbursement paperwork, payer dynamics and expectations of denials & appeals. Specifically, detailed documentation education including Letters of Medical Necessity (LOMN), Quantity and Order Limit Overrides, Lab documentation methods, federally funded plan navigation, HealthCare Marketplace education, and reimbursement paperwork including billing and coding standards with appeals.
Key Duties and Responsibilities:
- Obtains insurance verification and benefits via phone calls to insurance companies and leveraging additional sources such as insurance carrier websites. Accurately documents all information in the appropriate fields and or/account notes.
- Prepares benefit summaries and delivers the information to Health Care Professionals and Patients via phone, fax, email, and letter.
- Educates Health Care Providers and Staff with regard to prior authorization and appeals process & documentation including highly specific, payer-based requirements.
- Obtains and supplies all necessary prior authorization requirements to Health Care Professionals based on the insurance company’s requirements, following Cycle Pharma’s Compliance SOPs and regulatory guidance.
- Screens patient need for alternate funding scenarios including free drug and copay, following Cycle Pharma’s Compliance SOPs and regulatory guidance; enrolls appropriate patients.
- Triages orders to Specialty Pharmacies including follow-up calls/emails to gain knowledge of the status of those orders.
- Organizes, prioritizes and reviews daily work activity to ensure completion of assigned workload.
- Courteously answers telephone and/or emails and answers all questions in a timely manner. Maintains a positive working relationship with patients and caregivers, insurance companies, clinical personnel, co-workers, and management to promote teamwork, cooperation, and an image of service excellent and corporate stewardship for Cycle Pharma.
- Maintains and broadens skill and competency levels via formal training, participation in quality reviews, and self-education on the reimbursement landscape
- Performs other duties as required, such as cross-training and collaboration with Nurse Liaisons.
- Bachelor’s degree in Health Sciences field
- 5+ years conducting Benefit Investigations and Prior Authorizations, including documentation in the Healthcare Industry
- 5+ years knowledge in Copay and Free Drug Assistance Programs in the Healthcare Industry
- 5+ years working in a production environment using CRM and Telephony, such as SalesForce or Siebel
- Unquestionably high ethical standards and track record of ethical behavior, models compliance standards
- Experience working in a highly regulated industry and complying with strict regulations, policies and procedures. Deep understanding and experience creating materials on topics including patient access, hub services, specialty products in rare disease space, reimbursement, adherence programs and patient assistance programs
- Prior reimbursement experience with ability to communicate complex reimbursement scenarios to patients and medical professionals
- Strong case management background with skills to manage patient support services
- Familiarity with change management and the ability to identify best options based on business need
- Strong communication and presentation skills for internal and external customers
- Ability to effectively plan, prioritize, execute on business deliverables
- Ability to work with cross-functional partners (sales, market access, marketing, regulatory, compliance)
- Ability to multitask, problem solve and work independently
- Individual must possess and portray strong emotional resilience
- Individual must possess extraordinary positive attitude, exceptional listening skills, and strong verbal and written communication skills
- Strong ability to lead, initiate and implement programs or activities to gain, maintain and improve access of Cycle products
- Experience working with CRM platforms such as SalesForce, Veeva or Microsoft Dynamics.
- Able to travel (during non-Covid times) up to 50% to Health Care Providers, Specialty Pharmacies, and Headquarters for Training and Quarterly Business Reviews.
- Advanced degree in Health Science field
- 7+ years’ experience working in biotech/pharmaceutical industry for a drug manufacturer or Hub Services provider
- Rare disease experience
- Experience and relationships with disease specific providers and clinics
What makes this role special:
- Seek to have a profound impact on disease specific patients and their families.
- Work on a portfolio of multiple potential therapies.
- Develop strategies, as well as manage and execute.
- Help shape the culture and future of an emerging pharmaceutical company with a grand vision.
- Collaborate with a growing team of experienced professionals.
- Learn from a strong leadership team a with a proven history of success.
Please submit CVs and Resumes to: Careersus@cyclepharma.com
Cycle Pharmaceuticals embraces diversity and equality of opportunity. We are committed to building an inclusive and diverse team representing all backgrounds, with as wide a range of perspectives as possible, and harnessing industry-leading skills. We believe that the more inclusive we are, the better our work will be. We welcome and consider applications to join our team from all qualified candidates, regardless of their characteristics. We comply with all applicable laws and regulations on non-discrimination in employment (and recruitment), as well as work authorization and employment eligibility verification requirements.