Required: CPhT certification

Responsibilities:

• Performs patient onboarding, benefit verification, prior authorization, financial assistance and appeals processes, as needed, on behalf of patients and their physician to facilitate the process between the doctors’ office and pharmacy to triage and streamline prescription fulfillment.

• Provides above services for a health system’s ambulatory pharmacy, specialty pharmacy and/or outpatient infusion center environment, as requested.

• Interacts with patients and providers to obtain insurance benefits and patient information needed to request prior authorizations so that medications and other services rendered are reimbursed by payer.

• Ensure patient-specific reimbursement related information is obtained and available for review and for tracking of replacement product, including maintenance of files and documentation for PAP application submissions.

• Obtains appropriate signatures and documentation for completed PAP applications prior to submission of the application to the respective PAP.

• Completes patient adherence activities that may include notification of upcoming refills, coordination, tracking, and confirmation of prescription delivery.

• Works within health system’s electronic medical record system and other applicable systems (i.e., IndiCare™) to support workflow management and to document activities (i.e., retrieve information needed to deliver services, communicate status, and document outcome).

• Provides integrated services to the health system and its component parts to increase prescription capture rate, ensure timely delivery of infusion medications to be infused in the hospital setting, improve patient outcomes and reduce readmissions.

• Resolves barriers proactively that may affect reimbursement at assigned facilities and provides detailed updates to the Patient Access Management team

• Establish business relationships with assigned clinic staff, pharmacy, and hospital contacts, keeping them informed of significant changes in site-specific recovery potential based on changes to PAPs.

• Readily assists on special projects within job scope to improve reimbursement optimization when requested by management.

• Communicates patient and provider feedback to PHS management to enhance process improvement to enhance continuity of care.

• Interfaces appropriately with assigned key account associates with information relevant to additional products and services provided by Cencora and its subsidiaries.

• Demonstrates flexibility and adapts to changes in payer, pharmacy and patient assistance program processes and requirements.

• Provides temporary coverage to support clients and patients in the event of onsite resource absences.

• Performs related duties as assigned

• Degree, technical vocational training, or equivalent combination of experience and education.

• Bachelor's degree program preferred.

• Pharmacy Technician Certification Board (PTCB) certification is required.

Work experience:

• This position requires broad training in fields such as Medical Office Administration, Social Work, Medical Records/Billing, Benefit Verification, Patient Financial Services, Pharmacy, Nursing, or similar vocations generally obtained through completion of a 2-year Associate

• 2+ years of directly related or relevant experience

Skills and knowledge:

• Ability to communicate effectively both orally and in writing.

• Strong organizational skills; attention to detail

• Ability to work quickly and accurately under time and volume constraints.

• Ability to be proactive and tenaciously seek solutions under minimum supervision to improve customer satisfaction.

• Demonstrated competence in Microsoft Excel and Word

• Strong analytical skills

• Strong interpersonal skills

• Familiarity with insurance/claims processing, pharmaceutical products, services, software, and drug interactions

Physical requirements:

• The physical demands described here are representative of those that must be met by an associate to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Sedentary physical activity requiring reaching, sifting, lifting, finger dexterity, grasping, feeling, repetitive motions, talking and hearing. Visual requirement is for close vision, distance vision, peripheral vision, and ability to adjust focus. 75% or more time is spent looking directly at a computer.

• Associate is frequently required to stand, walk (or otherwise be mobile). Ability to deal with stressful situations as they arise.