Patient Copay Support Representative

Patient Support & Copay Program Services

- Respond to a high volume of inbound contacts from patients, caregivers, providers, pharmacies, and advocates regarding prescription costs, pharmacy processing issues, available access programs, enrollment, and eligibility screening.

- Explain common healthcare and pharmacy benefit concepts in plain language, including copays, deductibles, coinsurance, out-of-pocket maximums, coverage limitations, and accumulator/maximizer program impacts.

- Screen patients for manufacturer copay card and financial assistance program eligibility using established criteria and support appropriate enrollment, activation, and referral workflows.

- Assist with copay program questions, including enrollment status, card balance, annual limits, expiration, activation, and other program-related inquiries.

- Provide empathetic, high-touch customer service and help patients understand next steps while maintaining appropriate professional boundaries.

Insurance, Benefit Verification & Claim Support

- Contact payers and/or pharmacy benefit managers, as applicable, to obtain and document benefit information, coverage details, and patient responsibility information, including participation in accumulator or maximizer programs.

- Read and interpret explanation of benefits (EOB) information, prescription claim responses, patient responsibility amounts, insurance benefit information, and common pharmacy rejection messages within the scope of the assigned program.

- Research and resolve common rejected pharmacy claims using established procedures, including eligibility issues, refill-too-soon rejections, coordination-of-benefits issues, prior authorization requirements, plan limitations, and other third-party billing rejections.

- Coordinate with payers, pharmacy benefit managers, patients, pharmacies, providers, and internal teams to obtain information and move issues toward appropriate resolution.

- Monitor and communicate the status of pending prior authorizations, identify outstanding requirements, and coordinate with the appropriate internal team, payer, pharmacy, or provider office. This role does not make clinical determinations.

Documentation, Compliance & Escalation

- Maintain accurate patient and insurance information, including policy identification numbers, group numbers, BIN information, contact details, and other required data elements.

- Document patient interactions, benefit findings, claim activity, enrollment activity, commitments, and next steps accurately and chronologically in the designated CRM or case management system.

- Verify patient identity and follow all applicable HIPAA, privacy, information security, and client/program verification requirements before discussing protected information.

- Route clinical questions, legal inquiries, complaints, and escalated issues to the appropriate supervisor, Tier-2 resource, or specialized internal team using established escalation paths.

- Follow Omega and client policies, procedures, scripts, quality standards, and security requirements while handling protected health information and other confidential data.

Key Success Indicators/Attributes

- Consistently meets established program expectations for first-contact resolution, average handle time, quality assurance, documentation accuracy, attendance, and schedule adherence.

- Delivers professional, empathetic, and patient-centered service, including during emotionally sensitive or high-stress interactions.

- Demonstrates strong interpersonal, verbal, and written communication skills with patients, caregivers, physicians, nurses, pharmacists, pharmacies, payers, and internal partners.

- Maintains accuracy and attention to detail while navigating multiple systems, screens, workflows, and concurrent tasks.

- Demonstrates agility and willingness to work in a consistently evolving contact center environment and adapt to changes in programs, procedures, technology, and client requirements.

- Uses sound judgment to follow established procedures, recognize issues outside the role's scope, and escalate appropriately.

- Maintains confidentiality, professionalism, reliability, and a strong commitment to customer service.

Supervisory Responsibility

None required.

Work Environment

This role operates in a professional contact center environment, which may be onsite, hybrid, or remote depending on the assigned program and client requirements. The position routinely uses a computer, telephone/headset, dual monitors, and multiple web-based or client applications and requires sustained attention to voice and data-entry work.

Physical Demands

The physical demands are representative of those required to perform the essential functions of this role.

The position primarily involves sitting, speaking, hearing, typing, and viewing a computer screen for extended periods, with occasional standing and walking.

Position Type/Expected Hours of Work

This is a full-time, non-exempt position. Specific work hours, time zone coverage, weekend or holiday requirements, and onsite, hybrid, or remote expectations are based on the assigned program and client requirements. Flexibility may be required to support operational needs.

Required Education and Experience

- High School Diploma or GED required.

- Working knowledge of U.S. healthcare insurance concepts, including copays, deductibles, coinsurance, and out-of-pocket maximums, along with general pharmacy and healthcare terminology.

- Strong interpersonal, communication, and customer service skills, with the ability to remain calm and professional during sensitive or difficult interactions.

- Comfort with technology and the ability to navigate multiple applications, databases, CRM tools, and dual monitors while maintaining an effective voice interaction.

- Ability to multitask, follow established procedures, document accurately, protect confidential information, and escalate issues appropriately.

Preferred Education and Experience

- One to two years of experience in a pharmacy billing call center, retail pharmacy, medical front office, or healthcare-focused customer service environment.

- Active state Pharmacy Technician registration/licensure and national certification such as CPhT /PTCB or equivalent.

- Spanish/English bilingual capability.

- Additional post-secondary education or healthcare-related training.

Additional Eligibility Qualifications

- Ability and willingness to complete all required Omega, client, and program training, which may include emotional sensitivity, privacy, security, systems, and program-specific training.

- Ability to communicate effectively with patients and healthcare professionals, including physicians, nurses, pharmacists, and pharmacy staff.

Security Access Requirements

Access to protected health information, client systems, CRM/case management tools, telephony applications, payer or pharmacy benefit systems, and other assigned applications may be required based on job duties. All access is subject to Omega and client privacy, HIPAA, information security, and acceptable-use requirements.

Equal Employment Opportunity:

Omega Healthcare is an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, national origin, gender, age, sexual orientation, gender identity or expression, marital status, mental or physical disability, protected veteran status, genetic information, or any other basis protected by applicable law.

Omega Healthcare makes reasonable accommodations when needed for applicants and candidates with disabilities or religious observances. If reasonable accommodation is needed to participate in the hiring process, please contact Human Resources at [email protected].

Other Duties

This job description is not designed to cover every activity, duty, or responsibility required of the employee. Duties and responsibilities may change at any time with or without notice, and the employee may perform other duties as assigned.