Financial Assistance Coordinator

Position Title: Financial Assistance Coordinator

Department: Revenue Cycle Management / Financial Assistance

Reports to: Financial Assistance Supervisor

Position Type: Full-time, Non-Exempt

Position Overview:
The Financial Assistance Coordinator helps eligible patients identify, apply for, obtain, and maintain approved financial assistance for prescribed therapies and related coverage needs. The role coordinates manufacturer copay programs, independent charitable foundation support, manufacturer patient assistance and free-product programs, Medicare Extra Help and other benefit screening resources, approved internal assistance, and premium assistance programs. The coordinator provides accurate and compassionate guidance while protecting patient choice, privacy, documentation integrity, and compliance with each program's requirements.

Primary Responsibilities:

Review referrals, insurance information, patient statements, account information, and available documentation to identify potential financial assistance needs and appropriate approved resources.
Explain available assistance options, basic eligibility requirements, application steps, required documentation, renewal requirements, and known limitations using clear and neutral language.
Screen for manufacturer copay programs, independent charitable foundation grants, manufacturer patient assistance or free-product programs, Medicare Extra Help and other benefit resources, approved internal assistance, and premium assistance programs.
Obtain required patient consent and collect complete, current, and accurate supporting information within the coordinator's authorized scope.
Prepare and submit accurate applications and supporting documents through approved portals, secure electronic methods, telephone processes, or other authorized channels.
Coordinate with patients, authorized representatives, prescribers, manufacturer programs, independent foundations, health plans, government resources, and internal teams to resolve missing information and application barriers.
Enroll eligible patients in copay assistance programs, correctly associate covered medications with the applicable copay card, and accurately update patient accounts.
Monitor foundation funding availability and act promptly to enroll eligible patients when approved funds become available, without promising that funding will open, remain available, or be approved.
Process retroactive claims for previously eligible cases when appropriate and permitted by program requirements and company procedures.
Document each material action in CareTend or another approved system, including the source contacted, date, application status, outstanding requirements, approval period, available award amount or balance, expiration or renewal date, and next action.
Monitor open cases, grant balances, enrollment periods, premium due dates, renewal dates, document expirations, insurance changes, and assistance exhaustion to reduce avoidable treatment or coverage interruptions.
Assist patients with Medicare Extra Help and other approved benefit screening resources without representing that the coordinator determines government eligibility or provides legal, tax, insurance, or financial advice.
Coordinate premium assistance only through approved programs and workflows, maintain required proof and status information, and promptly escalate concerns involving plan selection, patient choice, funding sources, or payment conditions.
Process approved internal assistance only within written policy and documented authority. The coordinator may not independently waive, reduce, or forgive a patient's financial obligation.
Provide timely status updates and handoffs to Financial Assistance, Intake, Billing, Pharmacy Operations, Patient Services, and other authorized teams when assistance status affects patient service or account workflow.
Maintain organized work queues and complete assigned follow-up within department standards, program deadlines, and patient care priorities.
Participate in training, quality review, audits, corrective education, and process-improvement activities, and perform other duties within the general scope of the position as assigned.

Plus - may perform other duties as assigned.

Compliance and Documentation Standards:

Record and submit only information supported by the patient, prescriber, payer, or another authorized source. Never alter or suggest altering a diagnosis, income, household information, insurance status, coverage information, signature, or attestation to obtain assistance.
Never sign for a patient, prescriber, caregiver, or authorized representative unless documented legal authorization and the program's written process expressly permit it.
Complete administrative sections only as permitted. Do not make clinical statements, select a diagnosis, or complete an attestation reserved for the patient or licensed prescriber.
Verify each program's current eligibility rules, including restrictions involving Medicare, Medicaid, TRICARE, or other federal or state health care program coverage. Do not assume one program's rules apply to another.
Provide factual assistance information without steering a patient toward a particular drug, health plan, prescriber, or pharmacy for the purpose of obtaining or retaining assistance.
Protect confidential information by using assigned credentials, approved systems, secure communication methods, and the minimum necessary patient information. Preserve source documentation and maintain a clear audit trail.
Stop and escalate suspected fraud, inaccurate or conflicting documentation, duplicate assistance, conflicts of interest, patient complaints, privacy or security concerns, unclear program instructions, or any activity that may violate law, policy, or program terms.

Education:

High school diploma or equivalent required.
Additional education or training in healthcare administration, pharmacy, insurance, reimbursement, business, or a related field preferred.
No professional license or certification is required unless separately established by company policy or applicable law.

Experience:

One year of relevant customer service, healthcare administration, pharmacy, insurance, reimbursement, patient access, or financial assistance experience preferred; equivalent demonstrated capability may be considered.
Experience in specialty pharmacy, home infusion, manufacturer support programs, charitable foundation assistance, premium assistance, Medicare benefit resources, or another regulated healthcare environment preferred.

Technical / Specialized Knowledge, Skills, and Abilities:

Ability to learn and accurately apply program-specific eligibility, application, renewal, and documentation requirements.
Working knowledge of health insurance terminology, patient financial responsibility, Medicare Extra Help, and common financial assistance pathways.
Ability to protect confidential information and apply privacy, security, fraud-prevention, and documentation requirements.
Proficiency with electronic health or pharmacy systems, secure portals, telephone systems, email, Microsoft Office, and department tracking tools.
Strong reading comprehension, data-entry accuracy, basic mathematical ability, organization, and follow-through.
Clear and respectful verbal and written communication with patients, caregivers, prescribers, program representatives, and coworkers.
Ability to manage competing deadlines, identify urgent access concerns, and escalate rather than guess when instructions or facts are unclear.
Professional judgment, empathy, integrity, accountability, adaptability, and attention to detail.

Working Conditions:

This is a full-time position that primarily performs computer, telephone, documentation, and communication work in a professional office environment or another company-approved work location.
The role requires prolonged periods of sitting and frequent use of a computer and other standard office equipment, with occasional standing, walking, reaching, and lifting or moving office materials weighing up to 20 pounds.
Regular attendance and punctuality are essential. Some evening or weekend work may be required based on business needs. Regular travel is not expected, although occasional local travel may be assigned for training or another documented business need.
Because the position is non-exempt, all time worked must be accurately recorded. Overtime or work outside the assigned schedule requires advance approval, but all time actually worked must be reported and will be paid in accordance with applicable law and company policy.

Equal Opportunity Employer:
We are an equal opportunity employer committed to diversity and inclusion. We celebrate diversity and are dedicated to fostering an inclusive environment for all employees. River's Edge Specialty Pharmacy will consider reasonable accommodations for qualified applicants and employees as required by applicable law.