SUMMARY OF POSITION:

This position will support the management of patients requiring Specialty Pharmacy Medications. Providing prior authorization services, including insurance benefit investigation, copay assistance, and foundation support for the Specialty Medications. Responsible for the accurate billing and collection of third party and patient payments for products and services rendered.

FUNCTIONS OF POSITION:

1. Submit timely, accurate invoices to payer for products and services provided.
2. Correctly determine quantities and prices for products and services billed.
3. Verify services and products are correctly authorized and required documentation is on file.
4. Ensure all Medicare documentation is received from the medical provider and submitted to the pharmacy.
5. Manage and collect patient balances prior to prescription dispensing, or in accordance with company policy.
6. Ensure all required documentation for billing is completed and accurate prior to claim submission (i.e., medical claims billing).
7. Process reimbursement checks/payment in accordance with policy.
8. Review, research and resolve all third-party chargebacks in a timely manner.
9. Assist with any third-party audits, in accordance with company policy.
10. Processing of prescription exceptions including prior authorizations, triaging of referrals to other specialty pharmacies, and proactively identifying copay assistance opportunities.
11. Responsible for proactive communication to patients and providers regarding referral/prescription status.
12. Responsible for maintaining a deep understanding of and assisting patients with assistance programs enrollment, such as Chronic Disease Fund, confirming patient eligibility and all required reporting and documentation.
13. Handles telephone calls that do not require personal attention of the pharmacist, including those to physicians and third-party payers.
14. Maintains subject matter expertise pertaining to all billing practices including but not limited to third party adjudications, prior authorization, and patient financial assistance programs in order to coach retail pharmacy technicians and other support staff.

QUALIFICATIONS:

EDUCATION: High school diploma, or GED equivalent, required.

LICENSE: Missouri Pharmacy Technician license issued by Missouri Board of Pharmacy. Certification by the Pharmacy Technician Certification Board (PTCB) preferred.

EXPERIENCE:

• Three (3) to Five (5) years of retail pharmacy technician or medical billing experience. Specialty pharmacy experience preferred.
• Experience with direct patient counseling and excellent customer service skills are required.
• Experience communicating both verbally (on phone, one-on-one, to groups) and in writing (emails, letters, reports, presentations) to various audiences (work group, team, company management, prospective acquisitions, external clients).
• Experience providing customer service to internal and external customers, including meeting quality standards for services, and evaluation of customer satisfaction.

SPECIAL SKILLS:

• Strong customer service skills and independent problem solving is a requirement.
• Must have excellent communication skills and the ability to prioritize and multitask / change tasks frequently and quickly.
• Knowledge of drug products is preferred.
• Knowledge of requirements of the pharmaceutical industries Medication Patient Assistance Programs is helpful.
• Experience in processes related to submitting medical claims, including but not limited to Medicare submission, knowledgeable in EOB (explanation of benefits), remittance advice and adherence to timely filing limits.
• Must be competent with Microsoft Office applications, including Excel.
• Knowledge and skills related to computerized pharmacy systems, specialty prescription delivery systems, and third-party payors.
• Accountable to the Specialty Pharmacy Pharmacist and Director of Pharmacy for maintaining the highest professional standards.
• In personal and job-related decisions and actions, consistently demonstrates the values of integrity (doing the right thing), patient-centered (putting patients and families first), respect (valuing all people and embracing all differences), accountability (being responsible and taking action), and compassion (being empathetic).
• The position requires a high degree of planning and discretion ensuring optimization and compliance with various indigent recovery programs. The position requires the ability to apply new ideas, knowledge and skills gained from experience and education to current situation.

PHYSICAL:

May spend majority of shift standing or sitting at a desk and working on a computer.

• Considerable about of routine walking throughout hospital and clinics.
• Must be able to lift up to 35 pounds at a time.
• Must have good visual acuity to review medical records, manuals, and other references.
• Must have the ability to effectively understand and communicate with staff, patients, and outside agencies.
• May work with and be exposed to cytotoxic medications and other hazardous chemicals