Primary Responsibilities:

• Responsible for routing all incoming documentation for new patients, refills, and additional documentation for Specialty and Infusion pharmacy.

• Explains all Company programs and services to Referral sources and provider’s office staff regarding what to expect with Company services, contents of shipments, and patient rights.

• Acts as a liaison between Company, insurance, Pharma, co-pay assistance sources, and provider’s offices via phone, fax, and e-mail communications.

• Enters data requirements into tracking software. Transfers call to clinical staff for clinical education/assessment activities.

• Creates patient’s estimated cost of benefits with all pertinent information and attaches to record for use by customer care center of excellence.

• Notifies appropriate staff of relevant information gathered during calls to providers or patients that may affect a patient’s disease state, medication regimen or method of funding.

• Records and processes orders and/or inquiries received by mail, telephone and/or through direct patient contact.

• Maintains documentation of calls to and from patients, caregivers, insurance, providers, and Pharma.

• Creates patient activities as a reminder for the following tasks, including, but not limited to, follow-up calls, clinical assessments, referrals to Case Management, initiation of discharge, patient letter mailings, or other reminders as it relates to the patient’s care.

• Must maintain the established workflow within the Patient Care Access Department and adhere to the company/department’s Policy and Procedure manual.

• Responsible for coordinating manufacturer or nursing agency support when home teaching is required.

• Must maintain referral log on a daily basis and update with all pertinent information.

• Responsible for completing patient’s Estimated Cost of Benefits and able to explain to patient and others in the organization.

• Must be able to perform complete benefits investigation, including prior authorization and medical vs pharmacy determination.  The individual will also need to complete all payer documentation, including Medicare Certificates of Medical Necessity and DME Information Forms.

• Contacts referring nurses/coordinators according to the assigned team regarding insurance verification findings and patient issues, and status updates.

• Adheres to all company policies as indicated in the handbook and directives issued by management. Has reviewed Policy and Procedure manual.

• This is an office-based position.

Professional Competencies:

• Proficient with MS Excel, Word, and Outlook

• Demonstrated ability to meet tight deadlines

• Must be detail oriented with a high degree of accuracy

• Ability to work with all levels of internal management and staff, as well as outside clients and vendors

• Working knowledge of Medicare, Medicaid, and Commercial Insurance related to pharmacy billing, prior authorizations, insurance verification, and medical terminology preferred

• Must be knowledgeable in Medicare, Medicaid, Commercial insurance, and renal programs and how they apply to transplant and specialty patients

• Knowledgeable in the process of insurance verification and online prescription adjudication

Educational and Experience Requirements:

• High school diploma or equivalent

Licensure and Certification Requirements:

• Current unrestricted state pharmacy technician registration/licensure

• National or state pharmacy technician certification per applicable State Board of Pharmacy requirements

Contacts: