Specialty Pharmacy Patient Care Coordinator - Full time

Overview

The Specialty Pharmacy Patient Care Coordinator is responsible for receiving and/or processing prescriptions specifically related to specialty medications for various disease states, addressing and resolving rejected claims, conducting and completing necessary third party (insurance) specialty prior authorization requests. Performs duties of in coordinating and managing all aspects related to insurance benefit information, authorization and billing. Interacts with pharmacists, medical/clinical staff, fiscal personnel, department managers, access services staff, coding staff, billing assistants, interdisciplinary caregivers, and patients. Maintains a general knowledge of all the disease categories adopted by Specialty Pharmacy Management. May also contribute to research, projects and publications.

Key Essential Functions:

• Works with patients, family, and caregivers to help mitigate financial burden.
• Effectively communicates with provider regarding any issues that include, but are not limited to, pharmacy claims, insurance verification, benefits coordination, and copay cost/support.
• Verifies and monitors insurance coverage. Ensures that all payors are active and approvals are current before medications are processed and shipped.
• Specialty billing knowledge and accurate processing, including Medicare B benefits and coordination.
• Communicates with payor and/or pharmacy representatives to resolve approval, processing, shipping, and/or copay assistance issues.
• Answers and triages telephone calls. Receives information and refers calls to appropriate pharmacy personnel.
• Maintains an understanding of collaborative pharmacy sites/teams' functions, protocols, and communication requirements.
• Demonstrates working knowledge of EHR, Dispensing Software, Patient Management Software.

Additional Essential Functions:

• Assists the pharmacist and other technicians in preparing and processing medication orders/prescriptions.
• Assumes responsibility for inventory maintenance to ensure that quality in-date drug products and supplies are available when needed.
• Receives and enters payments while following PCI compliance regulations, as applicable.
• Proactively tracks and resolves shipping grievances and concerns.
• Reads departmental communications in a timely manner.
• Completes assigned learning modules within time requirements.
• Participates in quality assurance and performance improvement activities when requested.
• Maintains knowledge of specialty medication REMs programs and ensures prescriptions are processed within applicable guidelines.
• Follows all processes and procedures for proper management of controlled substances.
• Contributes to and participates in activities and policy/procedures related to specialty pharmacy accreditation.
• Learns and maintains knowledge of disease specific medications, which includes an understanding of specific manufacturer hub services programs and both internal and external access to specialty medications.
• Completes prior authorizations for prescription plans or pre certifications for medical coverage, as applicable.
• Contributes to specialty pharmacy, clinical, or other research projects and publications.
• Demonstrates flexibility and responsiveness to scheduling and time management needs.

Education, Experience and Certifications

High school diploma or a state high school equivalency certificate (GED) required.

Registration with state board of pharmacy per state of employment requirements within 30 days of hire.

Certification through Pharmacy Technician Certification Board (CPhT) or National Healthcareer Association (ExCPT) within 6 months of hire.

Associates degree preferred.

Three years pharmacy experience and two years call center or customer service experience highly preferred.

Retail pharmacy or healthcare/medical group experience and two years of healthcare related billing preferred.

Preferred experience of specialty clinical management process.

Experience working with providers and staff to complete medication prior authorizations and secure medication funding is preferred. Microsoft Office experience preferred. Membership in a valid professional technician organization such as NCAP, AAPT, etc. is encouraged, with evidence of active involvement preferred.

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