Specialist - Pharmacy Reimbursement- Full time- Day Shift- MRH: MRH - Pharmacy Oncology-East
Full Time
Hollywood, FL 33021
Posted
Job description
Summary:
Responsible for performing benefit coverage investigations, initiating, processing, resolving prior authorizations (including denials), helping patients obtain financial assistance from pharmacy related services. Coordinates enrollment, utilization, and ongoing eligibility for manufacturer patient assistance programs to ensure access to medications and compliance with program requirements. Responsible preparing monthly pharmaceutical savings reports and responding to patient assistance program audits.
Responsible for performing benefit coverage investigations, initiating, processing, resolving prior authorizations (including denials), helping patients obtain financial assistance from pharmacy related services. Coordinates enrollment, utilization, and ongoing eligibility for manufacturer patient assistance programs to ensure access to medications and compliance with program requirements. Responsible preparing monthly pharmaceutical savings reports and responding to patient assistance program audits.
Detailed responsibilities:
- Improves access to pharmaceutical therapy by performing pharmacy benefit investigation, prior authorizations, copay assistance, enrollment in manufacturer free drug programs, including medication replacement and appeals as appropriate.
- Performs pharmacy benefit investigation and applies knowledge and understanding of the coverage rules by third party payers, including Medicare and Medicaid. Identifies therapies that require certification of medical necessity. Works with providers and payers to obtain approval. Initiates support for appeals to denied authorizations for pharmacy services.
- Assesses, assists and enrolls patients that require financial assistance for pharmacy services. Contacts pharmaceutical companies to obtain information and enrolls patients into pharmaceutical patient assistance programs. Monitors and coordinates re-enrollment or transition into additional pharmacy service lines.
- Coordinates receipt, delivery and distribution of free drug, drug replacements and bulk pharmaceuticals.
- Processes patient financial documentation for pharmacy financial assistance eligibility. Develops reimbursement payments schedules for patients with special needs. Tracks status of expiring reimbursements and processes renewals for patients as appropriate.
- Participates in pharmacy reimbursement initiatives that increase patient access to pharmaceutical services and promotes cost savings to the health system.
- Ensures compliance with financial and regulatory requirements. Coordinates and ensures appropriates credit to patient accounts when applicable.
- Tracks, trends and reports financial data related to drug reimbursement and replacement transactions.
Competencies and skills:
Essential:
- STANDARDS OF BEHAVIOR: Acts in a manner that supports the standards of communication, respect, privacy, and teamwork by demonstrating a commitment to professional and ethical conduct.
- CUSTOMER SERVICE: Demonstrates commitment to service excellence by promptly addressing internal/external customer issues/requests, resolving concerns while maintaining a professional image and behavior to build and enhance the patient/family/customer experience.
- ACCOUNTABILITY: Accepts ownership of job roles and specific assignments/goals; works independently, takes responsibility for own actions; admits mistakes and judgment errors; and accepts constructive feedback. Connects personal work results to the accomplishment of team and organizational goals.
- RESPONDING TO CHANGE: Accepts change and adapts in a positive and productive manner; handles unexpected situations and changes in direction calmly and with confidence. Views new assignments and job responsibilities as an opportunity for growth.
- FINANCIAL COUNSELING - PATIENT SERVICES: Counsels patients on financial liability using available financial counseling tools to achieve maximum reimbursement for patient services.
- VERIFY INSURANCE: Verifies and enters insurance information and authorization/referral requirements.
- ANALYSIS AND DECISION MAKING - PHAP: Uses decision making processes and tools to analyze situations and make effective decisions.
- PATIENT AND FAMILY CENTERED CARE: "Provides Patient and Family Centered Care to patients, families, visitors and internal customers"
Education:
Essential:
Essential:
- High School Diploma or Equivalent
Credentials:
Essential:
Essential:
- Registered Pharmacy Technician - FL
- Certified Pharmacy Technician
Other information:
Complexity of Work: Requires critical thinking skills, effective communication skills, decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action.
Required Work Experience: Three (3) years of pharmacy experience. Proficient understanding of the delivery of healthcare across multiple service lines.
Complexity of Work: Requires critical thinking skills, effective communication skills, decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action.
Required Work Experience: Three (3) years of pharmacy experience. Proficient understanding of the delivery of healthcare across multiple service lines.
Working conditions:
Essential:
Essential:
- Bending and Stooping 80.00%
- Climbing 40.00%
- Keyboard Entry 80.00%
- Kneeling 40.00%
- Lifting or Carrying 0 - 25 lbs Non-Patient 80.00%
- Lifting or Carrying 25.01 lbs - 75 lbs Non-Patient 60.00%
- Pushing or Pulling 0 - 25 lbs Non-Patient 80.00%
- Pushing or Pulling 26 - 75 lbs Non-Patient 60.00%
- Pushing or Pulling > 75 lbs Non-Patient 40.00%
- Reaching 80.00%
- Repetitive Movement Hand/Arm 80.00%
- Running 60.00%
- Sitting 80.00%
- Squatting 80.00%
- Standing 80.00%
- Walking 80.00%
- Audible Speech 80.00%
- Hearing Acuity 80.00%
- Smelling Acuity 60.00%
- Depth Perception 80.00%
- Distinguish Color 80.00%
- Seeing - Far 80.00%
- Seeing - Near 80.00%
- Bio hazardous Waste 40.00%
- Biological Hazards - Respiratory 40.00%
- Biological Hazards - Skin or Ingestion 40.00%
- Blood and/or Bodily Fluids 60.00%
- Communicable Diseases and/or Pathogens 40.00%
- Cytotoxic Chemicals 80.00%
- Dust 80.00%
- Gas/Vapors/Fumes 60.00%
- Hazardous Chemicals 80.00%
- Hazardous Medication 80.00%
- Latex 80.00%
- Computer Monitor 80.00%
- Domestic Animals 40.00%
- Fire Risk 40.00%
- Heating Devices 60.00%
- Magnetic Fields 60.00%
- Moving Mechanical Parts 80.00%
- Needles/Sharp Objects 80.00%
- Potential Electric Shock 40.00%
- Wet or Slippery Surfaces 60.00%
Organizational Profile:
Since the opening of the one-story, 100-bed Memorial Hospital in 1953, the South Florida community has benefited from caring and compassionate healthcare at Memorial Regional Hospital. Today, with 553 beds and as the flagship facility of Memorial Healthcare System, Memorial Regional Hospital is one of Florida’s largest and most sophisticated hospitals, offering leading-edge care and technologies. Services include:
Since the opening of the one-story, 100-bed Memorial Hospital in 1953, the South Florida community has benefited from caring and compassionate healthcare at Memorial Regional Hospital. Today, with 553 beds and as the flagship facility of Memorial Healthcare System, Memorial Regional Hospital is one of Florida’s largest and most sophisticated hospitals, offering leading-edge care and technologies. Services include:
- Medical and Surgical Services
- Emergency Room and Level I Trauma Center
- Memorial Cancer Institute
- Memorial Cardiac and Vascular Institute
- Memorial Neuroscience Institute
- The Family Birthplace
- Women’s Services
- Wasie Neonatal Intensive Care Unit
Disclaimer:
This job description is not intended, nor should it be construed to be an exhaustive list of all responsibilities, skills, efforts or working conditions associated with the job. It is intended to indicate the general nature and level of work performed by employees within this classification.
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