Kaweah Health is a publicly owned, community healthcare organization that provides comprehensive health services to the greater Visalia area in central California. With more than 5,000 employees, Kaweah Health provides state-of-the-art medicine and high-quality preventive services in our acute care hospital, specialized health centers and clinics. Our eight-campus healthcare district has 613 beds and offers comprehensive health services across a broad continuum of care.   

It takes a special person to work for Kaweah Health. We serve a region where the needs are great, which makes the rewards even greater. Every day, we care for people facing unique challenges and in need of healing. Throughout it all, our focus is to make a difference, and we do — in the health of our patients, our loved ones, and our community.

Benefits Eligible

Work Shift

Department

QUALIFICATIONS

License /Certification
Required: Pharmacy Technician registration with the California State Board of Pharmacy


Education
Required: High school diploma or equivalent


Department Specific Requirements

If assigned to Infusion Services: One year of previous work experience as a pharmacy technician required. Experience with prior authorizations, treatment authorization requests, coordinating referrals and direct communication with providers, patients and staff preferred. Experience with infusion therapy (i.e. inpatient, infusion center, or home infusion pharmacy) preferred.

If assigned to Home Infusion Pharmacy: At least three years of experience working in a hospital or infusion setting required. Billing experience in a home infusion, infusion center, or clinic setting required. Knowledge of HCPCS and ICD-9/10 codes; principles of Medicare, Medicaid (Medi-Cal), and commercial insurance billing and contracts; basic medical terminology; proficiency with Microsoft Outlook, Word, Excel and other computer-based applications required.

JOB RESPONSIBILITIES
Essential

Coordinates initial and ongoing services with prescriber, pharmacy services, nursing services and patients.

Promotes services with prescribers, customers, and other departments, demonstrating a strong customer service orientation and a continuous positive image for Kaweah Health.

Validates insurance and obtains insurance authorization when required initially and ongoing.

Coordinates and provides documents and information to Patient Accounting services for billing and authorizations and serves as a resource to Finance and Patient Accounting division.

Receives all correspondence and inquiries related to patient referrals and accounts. Maintains regular communication with prescriber and patient about ordered therapy, coverage and ability to service patient including start date or informs prescriber if patient cannot be serviced due to insurance coverage or other reason(s). Certifies/recertifies services with appropriate personnel when appropriate.

Demonstrates and maintains knowledge of medications, insurance criteria for coverage for specified therapies, specific billing codes for each therapy, and expected payment for specific therapies administered.

Works to resolve operational issues/concerns relating to prior authorization requests, insurance compliance issues; triages issues to appropriate personnel and department management, as appropriate.

Understands and coordinates directly with pharmacy department to ensure adherence to 340B regulations. Verifies medication and administration charges daily ensuring all charges are accurate and appropriate.

Establishes and maintains patient charts, documentation, logs and files. Inputs information into computer, generate and use reports to ensure smooth workflow.

Maintains detailed and comprehensive knowledge of all insurance contracts.

Coordinates and performs auditing for billing compliance and optimization of reimbursement. Brings any reimbursement or compliance concerns to the attention of the Manager.

Answers telephone, takes messages as required, and refers technical/clinical problems to the clinical staff or Manager as appropriate or required by law.

Conforms to patient confidentiality standards.

Ensures financial feasibility of providing therapies at the time of authorization.

Addendum (essential for specific dept)

IF ASSIGNED TO HOME INFUSION PHARMACY ALSO RESPONSIBLE FOR:

Acts as liaison with Patient Accounting department to ensure proper billing and recoupment of payments; coordinates and oversees internal training of pharmacy tech billers. Responsible for dissemination of education specific to billing of home infusion pharmacy claims and ensures accuracy of billed claims along with revenue integrity for said claims. Works with pharmacy tech billers on difficult or denied claims to appeal denials and ensure payment. Maintains updated computerized inventory pricing, charge data masters, and HCPCS and ICD-9/ICD-10 codes. Assists pharmacists with daily operations of pharmacy. Assists pharmacy manager/coordinator with ongoing evaluation/assessment of changes in billing, coding, and administration of home infusion pharmacy services. Maintains detailed and comprehensive knowledge of all insurance contracts, assists manager/coordinator with periodic contract negotiations and fee for service rates for said contracts. Identifies and participates in quality improvement and process enhancement projects as assigned by management. Coordinates, copies, and delivers orders to pertinent staff, in pharmacy and in billing department, in a timely manner. Performs as a resource to staff, field nurses and families, and triaging issues to pharmacists, as appropriate. Occasionally makes patient visits/deliveries, and/or be on call for visits/deliveries.

IF ASSIGNED TO INFUSION CENTER ALSO RESPONSIBLE FOR:

Maintains records of memorandums of understanding (MOU) with referring providers and coordinates with pharmacy department and other departments as needed. Assists with marketing the outpatient infusion center and services provided to community providers and via telephone with outside-the-area providers.

Additional

Demonstrates the knowledge and skills necessary to provide care and services appropriate to the population served on the assigned unit or work area.

Performs other duties as assigned.

Pay Range

If you want to use your talents alongside people who face each day with courage and purpose, in an environment that empowers you to do your absolute best, this is where you belong.