POSITION SUMMARY:

Working as a drug access liaison specialist, supports patients, caregivers, providers, and pharmacies in navigating insurance benefits for all medications that are administered in hospital clinics, infusion centers, and/or home settings. The drug access liaison specialist’s role must understand how to navigate payer medical benefits policies and procedures to ensure patients appropriately receive their prescribed injectable therapies. This person needs to have a strong understanding and ability to identify patient medical information. This role requires the ability to independently interpret medical terminology, which may include but is not limited to an understanding of past medical histories, diagnosis, laboratory, and pathology results. Additionally, this person should have knowledge of medical billing coding in three areas of the site of care: provider, home infusion, and hospital billing. Under the direct supervision of the Manager of Drug Access, this person will identify patient insurance benefits, submit all required medical documentation to the payer for approval, and assist the patient in accessing the drug through the most appropriate site of care.

Position: Patient Intake Coordinator Specialty Pharmacy

Department: Pharmacy - Medical Benefit Authorization

Schedule: Per Diem

ESSENTIAL RESPONSIBILITIES / DUTIES

• An understanding of basic clinical skills related to medical terminology and coding for different disease states or medical conditions
• Skilled communicator with interpersonal communication skills that interact with carrier representatives, patients, and providers
• Comprehensively review patient insurance benefits to navigate drug access barriers
• Understands significant major medical policies as they relate to site of care, medical necessity and, if applicable, pharmacy benefits
• Triage and coordinate patients to the appropriate site of care to ensure patients  are accurately prescribed,  and receive  prescribed drug promptly
  • Includes understanding of drug access through hospital, home infusion, and pharmacy points of access
• Ability to review patient medical information through the hospital’s electronic medical records
• Liaise with patient’s relevant health care providers to support patient’s access to therapy and support services.
• Gather medical information and submit timely prior authorization for medications based on payer medical policies
  • Including but not limited to, the oversight of all authorizations and benefits related to medications that a healthcare provider administers
  • Understand prior authorization requirements, including dates of expiration, maximum units/doses
• Gather and  assist in the management  of  data reports related to reimbursement and drug access services
  • Identify and understand medical coding billing errors
• Provide assistance to management for all payer audits, collect and distribute pertinent patient information
• Have a strong understanding of Medicare payment policies
  • Ability to screen patients for medical necessity based on Medicare LCD and NCD requirements
• Support the Drug Access Hub as needed
• Refer patient to pharmacy Financial Assistance Team when appropriate
• Multitasking; ability to complete multiple projects on time.
• Establish milestone and checkpoints to ensure successful work/project completion; follows up on work efforts and takes corrective steps when needed to ensure work remains on track

Must adhere to all of BMC’s RESPECT behavioral standards

(The above statements in this job description are intended to depict the general nature and level of work assigned to the employee(s) in this job. The above is not intended to represent an exhaustive list of accountable duties and responsibilities required).

JOB REQUIREMENTS

EDUCATION:

• High school Diploma or equivalent is required
• Associate or Bachelor’s degree (preferred)

CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:

• Prior Authorization Certified Specialist program completion within the first 12 months of hire.
• Pharmacy Technician National Certification (preferred)

EXPERIENCE:

• Requires at least five years of experience working with insurance companies on appropriate billing for private or third party reimbursement, managed care, or clinical support
• Experience within a healthcare setting, such as a physician practice, patient assistance program, or similar pharmaceutical/biological support program, is preferred.
• Knowledge of private payer, Medicare and Medicaid structure, and specialty pharmacy and retail pharmacy processes
• Knowledge of operational processes within a  physician’s office and/or infusion center, specifically related to prior authorizations
• Ability to communicate reimbursement and access topics concisely and clearly to provider staff
• Reviewing patient insurance benefit options and validating prior authorization requirements
• Identifying alternate funding/financial assistance programs
• Coordinating with hospital patient support services programs representatives
• Proven ability to collaborate and work in teams to achieve results in a complex, fast-paced service environment

KNOWLEDGE, SKILLS & ABILITIES (KSA):

• Excellent English oral and written communication skills are required, as well as the ability to communicate professionally over the phone.
• Excellent interpersonal skills to provide superb personalized customer service and to instill confidence and to advocate for patients; ability to explain required information to customers in a comprehensible manner.
• Other professional skills and qualities: proactive demeanor, independently problem solve, organized, detail oriented, ability to self-direct through multitasking and prioritizing, dependable, empathetic, focused on quality service,  goal-oriented.
• Cultural sensitivity, understanding, and comfort with of various social, racial, and ethnic populations.
• Must practice discretion and confidentiality as the position deals with highly sensitive and private data.
• Ability to understand, explain, and actively promote the hospital’s objectives through direct coordination and commitment to the program’s goals.
• Flexibility to adapt to changes in the departmental needs, including but not limited to offering assistance to other team members, adjusting assignments, etc.
• Highly proficient in Microsoft Office, particularly Excel, Word, and Outlook. Ability to quickly learn other relevant applications that support patient care management and assigned responsibilities; and ability to extract necessary information.

Compensation Range:

This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensures as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, BMCHS offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), discretionary annual bonuses and merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family well-being. 

NOTE: This range is based on Boston-area data, and is subject to modification based on geographic location.

Equal Opportunity Employer/Disabled/Veterans

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