Manager, CAPS Center Operations

Overview

Title:
Benefit and Patient Assistance Qualification Analyst, CAPS Center Operations

Reports to:
Supervisor, Operations

Summary:

The Benefit and Patient Assistance Qualification Analyst, CAPS Center Operations is responsible for investigating and as applicable obtaining accurate major medical and pharmacy insurance benefits for patients for whom we have received a benefit request or program enrollment.

Responsibilities:

The Benefit and Patient Assistance Qualification Analyst, CAPS Center Operations responsibilities include, but are not limited to the following:

  • Benefit Verification:
    • Performing patient level benefits verifications as applicable for all major medical and pharmacy benefits plans
    • Accurate documentation of benefits in the CAPS system
    • Completion of the template forms that provide patient level benefits Coverage Determination Summary, as applicable.
    • As applicable, coordination of prior authorizations based on payer guidelines and in compliance with law, regulation or guidance
  • Patient Assistance Qualifications
    • Review of patient assistance enrollment forms and any supporting documentation to assess patient eligibility for participation as per SOPs and program guidelines
    • Determination of patient’s eligibility based upon program criteria for qualification
    • Communication of patient’s eligibility to patient based upon program criteria for qualification
    • Communication of patient’s eligibility to the respective consignment pharmacy
  • Reporting of Adverse Events/ Product Complaint inquiries received in accordance with SOP and good manufacturer practices
  • Other duties as assigned by manager

 

Critical Skills:

The candidate must possess the following:

  • Detail oriented
  • Professional telephone etiquette
  • Basic computer knowledge
  • Ability to multitask effectively
  • Ability to recognize emotions and their effects
  • Sureness about self-worth and capabilities
  • Manage disruptive impulses
  • Maintain standards of honesty and integrity
  • Take responsibility for performance
  • Be adaptable and handle change with flexibility
  • Be innovative and open to new ideas
  • Achievement driven; constant striving to improve or to meet a standard of excellence
  • Align with the goals of the group or organization
  • Ready to take initiative and act on opportunities
  • Be optimistic and pursue goals persistently despite obstacles and setbacks
  • Be service oriented and anticipate, recognize and meet needs of others, including patients and care partners
  • Communicate clearly and send clear messages

 

Education and Experience:

  • High School diploma or equivalent is required
  • Minimum of (two) 2 years’ payer benefits experience is required
  • Insurance reimbursement/prior authorization background/experience is preferred
  • Bi-lingual in English and Spanish or Chinese/Mandarin is a plus

 

Physical Demands:

The candidate must possess the following abilities:

  • Ability to sit for extended periods of time
  • Ability to travel as needed

 

Any offer of employment is contingent on completion of a background check and drug screen to company standard.

job application

  • Please attach your Resume