Patient Services Representative

From intake to outcomes, CareMetx is dedicated to delivering industry-leading patient access solutions and support services that help patients quickly start and stay on specialty therapy treatments. We provide scalable, efficient digital hub services for pharmaceutical companies and healthcare providers, streamlining workflows with seamless integration for patient enrollment, consent, and prior authorization. Our best-in-class patient support services enhance every step of care, connecting patients, providers, and brands to drive better outcomes and accelerate time-to-therapy.

Job Title: Patient Services Representative

POSITION SUMMARY:

The Patient Services Representative is responsible for providing well defined services to patients, providers and caregivers. Team members will work interactively with patients and their healthcare providers to complete enrollment activities, answer basic program inquiries, and help coordinate access to therapies through the patient's healthcare provider.

PRIMARY DUTIES AND RESPONSIBILITIES:

• Depending on the specific contracted services, an associate may perform one or more of the following activities: Inbound Phone Queue/General Program Inquiries; Determination for support programs (Copay, Patient Assistance Program, Medicaid, etc.); Pharmacy triage and coordination; Order processing for wholesale orders; Other follow-up activities (missing info, prior authorization, etc.).
• Intakes and reports adverse events as directed.
• Researches and resolves any claim denials or underpayment of claims.
• Effectively utilizes various means for collecting information using program approved methods, which could include phone, fax, mail, and online methods.
• Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly.
• Reports any trends or delays to program management (e.g. billing denials, claim denials, pricing errors, payments, etc.).
• Ensures all program correspondence and communication (phone, fax, mail, etc.) meets quality standards.
• Works with patient, provider or internal shared services to ensure all necessary documentation is received and complete in accordance with program policy.
• Works on problems of moderate scope where analysis of data requires a review of a variety of factors. Exercises judgment within defined standard operating procedures to determine appropriate action.
• Required to be self-motivated, working from a queue (phone or system). Expected to perform work in accordance with defined standard operating procedures. Management will monitor queues and provide active feedback as required.
• Performs related duties as assigned.

EXPERIENCE AND EDUCATIONAL REQUIREMENTS:

• High school diploma or GED required.
• Requires a minimum of three (3) years directly related and progressively responsible experience in customer service, medical billing and coding, benefits verification, healthcare, business administration or similar vocations.
• An equivalent combination of education and experience will be considered. A bachelor's degree is preferred.

MINIMUM SKILLS, KNOWLEDGE AND ABILITY REQUIREMENTS:

• Strong customer service experience.
• Ability to communicate effectively both orally and in writing.
• Ability to build productive internal and external working relationships.
• Strong interpersonal skills.
• Basic analytical skills.
• Strong organizational skills and attention to detail.
• General knowledge of the healthcare industry is preferred.
• Proficient with Microsoft Excel, Outlook and Word.
• Developing professional expertise; applies company policies and procedures to resolve a variety of issues.

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee is regularly required to sit.
• The employee must occasionally lift and/or move up to 10 pounds.

Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.

Schedule:

• Must be flexible on schedule and hours.
• Some Travel may be required.

CareMetx considers equivalent combinations of experience and education for most jobs. All candidates who believe they possess equivalent experience and education are encouraged to apply.

At CareMetx we work hard, we believe in what we do, and we want to be a company that does right by our employees. Our niche industry is an integral player in getting specialty products and devices to the patients who need them by managing reimbursements for those products, identifying alternative funding when insurers do not pay, and providing clinical services.

CareMetx is an equal employment opportunity employer. All qualified applicants will receive consideration for employment and will not be discriminated against based on race, color, sex, sexual orientation, gender identity, religion, disability, age, genetic information, veteran status, ancestry, or national or ethnic origin.

Artificial Intelligence in Our Recruiting and Employment Process

CareMetx uses artificial intelligence and automated decision-making technology to support parts of our recruiting, hiring, and employment process, including screening applications, scheduling interviews, and evaluating candidate qualifications. These tools support, not replace, human judgment. A qualified member of our team reviews and makes all final hiring and employment decisions.

CareMetx does not develop or use AI tools with the intent to discriminate against applicants or employees on the basis of race, color, religion, sex, age, sexual orientation, national origin, disability, veteran status, or any other protected characteristic.