Coordinator Medication Reimbursement in Kansas City, Missouri at North Kansas City Hospital

JOB DESCRIPTION

SUMMARY: Under the supervision of the Pharmacy Director, proactively performs an ongoing analysis of historical and current outpatient infusion medication utilization, network contracts, and market intelligence to create methodology and reporting mechanism for trend forecasting in support of contractual terms, new programs and fiscal stability. Responsible for outpatient infusion medication processes and outcomes in the

following areas: (1) drug product contracting, selection, procurement, (2) patient assistance program compliance, monthly reporting, dispensing patterns, and inventory process, (3) inventory control and billing processes, (4) information support systems/technology development. As a member of the pharmacy team, collaborates with the team to plan, organize and operate the outpatient infusion clinic to achieve goals, meet customer needs and assure high quality services and medications. Coordinates practice model dealing exclusively with medications that are high in cost, require special handling, are subject to limited or restricted distribution, require ongoing assessment, treat rare diseases, or require active monitoring of side effects; with an increased emphasis on patient management, medication adherence, collaboration with other members of the health care team, an ability to use metrics to drive optimization of patient care, and an ability to assist the patient to access additional supportive resources. EXPERIENCE: Five years of experience in healthcare or related field. OTHER: Two years of experience working with managed care insurance companies and/or Medicare/Medicaid. Two years of experience working with medical and pharmacy benefit prior authorization process. Two years of experience working with manufacturer provided free drug programs. Two years of experience working with specialty pharmacy processes.

LICENSURE/CERTIFICATIONS

(1&2) Required: PTCB (Pharmacy Technician Certification Board), CPhT (Certified Pharmacy Technician)

EDUCATION

Required: High School or Equivalent

JOB STANDARDS

Validate benefit information before a patient arrives for an appointment and verify details thoroughly to ensure a comprehensive claims process that helps prevent revenue loss and enhances fiscal stability of outpatient infusion clinic. Contact payers and obtain pre-authorizations to meet payer criteria before submitting the request and outline how long it will take to review and approve/deny the pre-authorization. Ensure insurance coverage requests are submitted along with all necessary documentation.

Conduct patient scheduling process by receiving referrals, screening patient demographic information, conducting benefits investigation, determining payer coverage for specialty drugs, and exploring opportunities for patient financial assistance for qualified candidates.

Support patient care by coordinating with an integrated team of health care providers, providing requested clinical data and information to optimize therapy by ensuring appropriateness and safety of medication use, and to promote and monitor adherence and persistency.

Act as a liaison for manufacturer provided medication assistance programs for healthcare staff and patients. Identifies qualified medication assistance program participants in accordance with eligibility requirements.

Coordinating the processing, distribution, and delivery of referrals while maintaining product integrity, managing inventory of specialty medications, following up with patients to ensure that they receive medications, and billing for infusion management services rendered.

Defining, collecting, integrating, analyzing, and reporting data to promote and facilitate optimal outpatient infusion treatment outcomes and evaluate pharmacoeconomic impact of service offerings.

Perform other tasks as assigned by Pharmacy Management.