Under general supervision of a pharmacist, verifies insurance eligibility, benefits, verification, prior authorization, and researches denied services to ensure payments are processed on a timely basis. Acts as a liaison to ensure accurate processing of all claims. Enrolls patients in pharmacy services and ensures patients have timely access to medication and medication refills. Works with pharmacists to ensure appropriate medication therapy is selected and optimized to meet the patient?s needs.
Talent Pool: Allied Health
Performs benefits investigations on all patients receiving selected medications.
Obtains insurance prior authorizations or pre-certifications for insured patients
Coordinates with manufacturer assistance programs for uninsured or underinsured patients and coordinates manufacturer drug replacement (if applicable)
Acts as a liaison between the patient, clinics (if applicable), infusion centers (if applicable) and pharmacy.
Assists patients with copay assistance via manufacturer programs and grant foundations.
Interact with physicians, nurses, and other health care providers in a courteous and professional manner and display the highest level of customer service, attentiveness, and consideration possible in all situations
Utilize internally developed systems, commercial vendor software (to track patient eligibility, prescriptions, patient communications and program enrollment) and inpatient and outpatient clinical, scheduling, and financial systems as necessary (e.g. Cone Health Link - CHL).
Work collaboratively with care team to coordinate refill phone calls to patients and follow up on medication delivery.
Works as a patient advocate and functions as a liaison between the patient and payer to answer reimbursement questions and avoid insurance delays.
Works collaboratively with clinical pharmacists and care team to obtain clinical and financial information needed for program enrollment and prior authorization for insured and uninsured patients.
EDUCATION: Required: High school diploma or certificate of equivalency to include basic arithmetic, algebra, reading, and writing as well as some basic chemistry skills (ability to identify medications requiring specialized handling).
Preferred:
Associates Degree in Pharmacy Technology; Bachelors in medical or science field
EXPERIENCE: Required: Three years of pharmacy technician work experience or three years prior authorization and/or copay assistance programs work experience or three years combined pharmacy technician/prior authorization and copay assistance work experience.
LICENSURE/CERTIFICATION/REGISTRY/LISTING: REQUIRED
Certified Pharmacy Tech (CPhT)
PREFERRED:
ASHP Billing & Reimbursement Certificate
