CAP Team Lead
Through innovation, technology, and unparalleled customer service, TrialCard’s passionate people provide patient-centric solutions to the pharmaceutical industry that improve access, affordability, and adherence to enhance patients’ lives. We work tirelessly on the behalf of our clients, because when they succeed, so do we.
That’s not to say we are all work and no play. TrialCard is an open workplace with fun, energetic people united for a common purpose. In fact, we don’t even refer to each other as employees. We’re team members. We foster a culture that encourages individual personality.
As a Program Lead, you will join our team on a journey to help eliminate barriers for patients, increase their access to medications, and help them receive lifesaving treatments while working in an environment that nurtures you.
The Program Lead is primarily responsible for handling the day-to-day communications between the program team and the client field sales force (depending on program needs) primarily focused on activities within reimbursement services. This includes collaborating with internal and external teams, program managers, and operational teams to support reimbursement services within the scope of the program.
- Primary point of contact for client field personnel (sales representatives, field reimbursement personnel / dependent on program design).
- Liaise between client field force and program team (based on program requirements/needs).
- Problem solves issues with autonomy and serves as the first line of escalation for complex reimbursement issues for field team and internal program personnel
- Provide information on relevant regional challenges and updates to TrialCard Field Sales Liaison for communication to client field leadership
- Establishes relationships, develops trust, and maintains rapport with client team (field or non-field support)
- Keeps the program management abreast on all aspects of field communications and escalations
- Communicates and coordinates with inter-departmental stakeholders to resolve program specific escalations, conflicts and/or questions
- Assistance to key accounts and key account Care Coordinators/Case Managers (based on program requirements/needs) to help overcome access barriers for client stakeholders
- Initial triage of program escalations, provide immediate resolution when applicable and escalate to Program Supervisor when related to personnel, or communicates and coordinates with inter-departmental stakeholders to resolve program specific escalations, conflicts and/or questions
- Proactively identify potential areas of opportunity or risk based on escalation trends and collaborate with TrialCard program management, program personnel along with Field Sales Liaison for proposal and/or resolution
- Perform thorough insurance benefit investigations, and triage assigned cases according to program standard operating procedures, communicate insurance coverage to patients and providers, guide and follow up on prior authorizations, and assist with appeal processes based on the program’s business requirements
- Educate and influence program teammates to perform processes as defined while ensuring excellent customer service at all times
Incumbent may be asked to perform related job duties that are not specifically set-forth in this job description
- Bachelor’s degree and 3 years of reimbursement/insurance, healthcare billing, physician office, health insurance processing preferred or in lieu of a degree, a High School diploma or equivalent with 5 years of reimbursement/insurance, healthcare billing, physician office, health insurance processing
- Must be on the IMM CAP Team
- Excellent consultative, listening, communication, and analytical skills
- Extensive knowledge of pharmacy benefit methodologies for pharmaceuticals
- Extensive knowledge of medical benefit methodologies for pharmaceuticals and administration of pharmaceuticals
- Extensive knowledge of Medicare, Medicaid, and private payer payment methodologies
Ability to solve complex escalations using situational analysis, process evaluation and system analysis