Care Coordinator

Position Summary

We are seeking a Care Coordinator (CC) to facilitate reimbursement and access to medications for patients through payer research and HCP education and support. This position plays a key role in supporting the patient services team, ensuring alignment with organizational goals, operational excellence, and compliance standards. The CC will be assigned to a geography or aligned accounts and will manage daily activities that support appropriate patient access to products, acting as a liaison to other patient assistance and reimbursement support services required to support the program.

Key Responsibilities

• Engage with HCPs and their staff using a multi-channel approach to enhance experience, utilizing approved tools, to support and address questions about product coverage and requirements needed for reimbursement.
• Support the entire reimbursement journey from patient enrollment or initiation, access determination, and payer prior authorization processes through appeals/denials requirements.
• Educate HCPs and office staff on available patient assistance programs and explain the importance of their role in facilitating access to therapy for appropriate, eligible patients.
• Serve as payer and pharmacy expert for a defined territory/geography and proactively communicate changes to key stakeholders, both internal and external; coordinate support with other patient service team members or clients as appropriate.
• Identify market access trends from local, regional, or national payers in an assigned territory/geography, and partner with internal and client teams to enable appropriate patient access and/or support patient pull-through programs.
• Maintain and grow knowledge of national, regional, local, and account market dynamics, including coverage and prior authorization requirements.
• Analyze an assigned territory using reporting and analytics tools to execute comprehensive territory support, facilitate strategic decision making, and identify trends and areas of focus.
• Monitor and meet program SLAs, KPIs, and other established metrics.
• Adapt and pivot quickly to manage change and complexity, including flexing as markets, policies, and dynamics change; proactively managing through conflicts; and navigating the complexity of accounts and the patient journey.
• Maintain and grow knowledge of hub and specialty pharmacy channels to improve HCP office and patient support.
• Work collaboratively to share insights into customer needs, potential barriers, and payer issues/opportunities for product access.
• Collaborate with client Reimbursment Access Managers to support territories and HCP accounts.
• Identify key customer insights through effective questioning, critical thinking, and problem solving; analyze and disseminate data and information as appropriate to partners.
• Execute business in accordance with client values and to the highest ethical, legal, and compliance standards.

Qualifications

• Education: Bachelor's degree or advanced degree preferred.
• Licensure/Certification: Not applicable.
• Experience: Minimum three years' experience in the public or private third-party reimbursement arena or pharmaceutical industry in managed care, clinical support, or sales.
• Skills:  
  • Specialty pharmacy, hub, or patient services experience working with HCPs and payers to remove reimbursement barriers to specialty products.
  • Strong functional knowledge of specialty pharmacy and health insurance and benefits (e.g., Medicare Part D, commercial, and Medicaid), with a solid understanding of insurance eligibility, benefit verification, prior authorization, reimbursement coverage, appealing insurance denials, financial assistance, co-pay support, and bridge programs.
  • Knowledge of Centers for Medicare & Medicaid Services (CMS) policies and processes, with expertise in Medicare Part D (Pharmacy Benefit design and coverage policy) a plus.
  • Knowledge of Managed Care, Government, and Federal payer sectors, as well as Integrated Delivery Networks/Integrated Health Systems, a plus.
  • Proficiency in Microsoft Office products required, with advanced knowledge of Tableau, Excel, or other report generators, and the ability to analyze data to determine areas requiring focus.
  • High proficiency with complex patient access CRMs (such as Salesforce.com, Veeva, or CourierHealth) and the ability to efficiently navigate multiple systems while performing specific tasks on each.
  • Advanced problem solving, research, and analytical skills.
  • Advanced communication skills, both written and verbal, with required data entry accuracy.
  • Ability to multi-task and manage time independently; client interaction experience preferred.

Desired Attributes

• Ability to operate as a "team player" in collaboration with multiple internal and external stakeholders.
• Demonstrates a patient and provider-centric service mindset, with excellent customer service skills (call center experience preferred).
• Acts with a high sense of urgency and attention to detail.
• Strong team player, willing to roll up their sleeves to support other PAMs and contracted KPIs.

Work Environment

• Location: Remote / field-based, assigned to a geography or aligned accounts.
• Schedule: Full-time, 40 hours per week, Monday–Friday during program operating hours.
• Occasional weekends and holidays depending on the needs of healthcare providers or client requests. Occasional travel may be required (less than 10%).
• Regular meetings with the patient services team, client Reimbursement Field Access Managers (FAM), and other internal and external stakeholders to ensure alignment.

Key Essential Functions

• Customer-facing role; must be able to work with varying levels of staff and in direct contact with HCPs, patients, and the client
• Must be able to travel occasionally (less than 10%) to support territory or account needs.
• Must be able to efficiently navigate multiple CRM and reporting systems while maintaining data entry accuracy for extended periods.
• Must be able to work remotely/in the field with reliable connectivity to support HCP, patient, and client engagement across an assigned territory.

Employment Classification

Status: Full-time
FLSA: Non-Exempt

Equal Employment Opportunity (EEO) Statement

Gifthealth is an Equal Opportunity Employer and prohibits discrimination and harassment of any kind. All employment decisions are made without regard to race, color, religion, sex, sexual orientation, gender identity, transgender status, national origin, age, disability, veteran status, or any other legally protected status.

Disclaimer

This job description is intended to describe the general nature and level of work being performed. It is not intended to be an exhaustive list of all responsibilities, duties, or skills required of personnel.Gifthealth reserves the right to modify job duties or descriptions at any time.