PHRN Benefits

2 weeks ago

Ortigas Metro Manila, Philippines Omega Healthcare Management Services Inc. Full time ₱300,000 - ₱600,000 per year

Coverage and Access Specialist (PHRN)

  • · Professionally and compliantly interact with insurance payer representatives during outbound phone calls for benefit verifications (New BVs, Annual reverification BVs and Bridge Eligibility Checks) and coverage exception follow up calls (Prior Authorization (Pas), Non- Formulary Exceptions (NFEs) and Appeals)
  • · Volume and case type to be worked to be determined by Novartis, but in collaboration with supplier based on current SLAs within the PSC and expected agent productivity
  • · Accurately and concisely document payer interactions to inform cross-functional partners on the patient's coverage status
  • · Adhere to job aids and work instructions for case processing and case cadence
  • · Prepare proper documentation and notifications; perform proper escalation, tracking, and follow-up
  • · Adhere to Service Level Agreements (SLAs), Key Performance Indicators (KPIs), productivity, and quality metrics
  • · Promptly and courteously respond to tasks and notifications from Case Management counterparts
  • · Leverage dual monitors and technological solutions to support the Coverage & Access activities
  • · Responsible for identifying and reporting adverse events via the established Novartis systems as per applicable processes
  • Professionally and compliantly interact through direct outbound calls to the patients to bypass third party restrictions with payers

Care Navigator (PHRN)

  • · Develop and maintain Subject Matter Expert (SME) level knowledge of the relevant brand and customer workstreams for the specific assigned program
  • · Learn and utilize protocols to respond to customer phone, chat, fax, SMS / text, mail, and e-mail inquiries as well as other communication channels in a prompt and courteous manner
  • · Professionally and compliantly interact with customers, relevant Novartis associates, and other external contacts during inbound and outbound phone calls
  • · Manage assigned cases throughout the patient journey; perform proper and timely escalation, tracking, triage and follow-up where required
  • · Handle complex interactions and/or cases as it pertains to navigating insurances and financial assistance
  • · Adhere to call guides, job aides and work instructions for case processing and case cadence
  • · Adhere to Service Level Agreements (SLAs), Key Performance Indicators (KPIs), productivity, and quality metrics
  • · Leverage dual monitors and technological solutions to support Case Management activities
  • · Accurately and concisely document all interactions to inform cross-functional partners on the relevant status details
  • · Promptly and courteously respond to tasks and notifications from PSC counterparts
  • · As applicable, raise innovative ideas which will drive improved efficiency and effectiveness of customer service to Supervisors
  • · Responsible for identifying and reporting adverse events via the established Novartis systems as per applicable processes
  • Professionally and compliantly interact through direct outbound conference calls with the payer and the patient, to bypass third party restrictions with payers

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