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Coordinates, processes and manages manufacturer free drug program participants. Communicates with providers, office staff, & patients to obtain medication orders & financial information, to submit application to manufacturer programs. Communicates with system denials & revenue integrity teams to review claim edits & denials related to pharmaceuticals to ensure proper billing & payment. The successful candidate will ensure timely and accurate completion pharmacy patient access related needs. The candidate should have a strong knowledge of pharmacy and ability to communicate effectively while providing superb customer service.

MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Bachelor’s degree AND One (1) year of leadership, healthcare, or pharmacy experience;

OR

Associates degree AND Three (3) year’s pharmacy, leadership, or healthcare experience;

OR

High school diploma or equivalent AND Five (5) year’s pharmacy, leadership, or healthcare experience.

2. Must possess current licensure as required by state board where services will be provided:   

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position.  They are not intended to be constructed as an all-inclusive list of all responsibilities and duties.  Other duties may be assigned.

1. Manages and monitors the workflow of manufacturer free drug programs to provide efficient patient care.

2. Routinely evaluates patient workload and provides recommendations for redistributing in efficient and equitable manner.

3. Gathers and documents patient demographics, insurance information, financial status, and other data as needed.

4. Initiates follow up communication, schedules deliveries as needed, and works closely with patient care team on treatment plans.

5. Conducts and documents staff departmental orientation and training.   Manages new employee orientation in all enterprise pharmacy solutions service areas.

6. Drafts various correspondence letters, denial appeals, and referrals when necessary.

7. Develops and maintains strong working relationships with external, free drug programs, foundations, and vendors.

8. Performs medical benefit prior authorizations & benefit investigations for medications provided in clinics or infusion centers at various system facilities as requested.

9. Provides suggestions for staffing as needed based on planned and unplanned employee absences.

10. Manages & maintains all patient records in a timely and complete manner following department templates and guidelines.

11. Meets with DOPs of assigned hospitals on a routine basis to ensure high quality of service is being met.

12. Communicates with system denials team to resolve medication related denials, including pulling proof of medical necessity and coordinating written appeals from providers or clinical team.

13. Communicates with system revenue integrity team to ensure coding & billing quantities are accurate to our knowledge prior to billing in attempt to limit denials.

14. Manages & maintains current state and national registration/certifications.

15. Performs in a manner that promotes the work of the pharmacy patient access team and manages expansion of services at assigned sites as needed.

16. Extracts clinical notes, labs, and other scanned media in patient’s electronic medical record as necessary to complete assigned tasks.

17. Participates in division meetings with manager.

18. Consistently ensures that department and hospital policies and procedures are followed and updated as necessary.

19. Demonstrates the knowledge and skills necessary to communicate with patients, providers, & payers.

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

1. While performing the duties of this position, the employee is required to sit for long periods of time. 

2. Dexterity required to finger, handle, and reach. 

SKILLS AND ABILITIES:

1. Must possess a high level of interpersonal skills and poise.

2. Excellent verbal, written and decision making skills.

3. Knowledge of drugs, drugs dosing, indications, and proper administration preferred.

4. Must be polite and respectful when communicating with staff, physicians, patients and families. Must approach interpersonal relations in a positive manner.

Additional Job Description:

Scheduled Weekly Hours:

40

Shift:

Exempt/Non-Exempt:

United States of America (Exempt)

Company:

SYSTEM West Virginia University Health System

Cost Center:

249 SYSTEM Pharmacy Business Operations

Address:

781 Chestnut Ridge Road

Morgantown

West Virginia

Equal Opportunity Employer

 

West Virginia University Health System and its subsidiaries (collectively "WVUHS") is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. WVUHS strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. All WVUHS employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.