Pharmacy Coordinator- Outpatient Infusion, Full Time
North Mississippi Medical Center
Tupelo, MS
Full-time
Pharmacy
Posted on January 5, 2022
Essential Functions:
Referral/Pre-certifications/Prior Authorization:
Patient Care:
Referral/Pre-certifications/Prior Authorization:
- Responsible for liaison functions in 340 eligible provider based clinics to optimize referrals and data capture for specialty pharmacy prescriptions and infusion drugs
- Responsible for coordinating service authorizations related to SPRX and related services of infusion as required through both medical and pharmacy benefits and documenting in multiple EMR.
- Directly responsible for data extractions and analysis from multiple EMRs and financial systems to capture referrals
- Assist clinic staff in coordinating prescription referrals and working with patients through financial counseling
- Directly responsible for functions of financial coordination and screening of SPRX and home orders referrals for patients regarding patient financial responsibilities and planning.
- Clinic 340B program optimization for specialty drugs, including tracking of PBM contracting and expansion
- Responsible for the coordinating reporting of insurance benefits and approval requirements for patients seeking SP services
- Responsible for the submission of detailed patient records to insurance carriers for prior authorization and billing as an extension of the Specialty Pharmacy and Infusion
- Responsible for the accurate reporting of patient deductibles, co-pays, and any insurance plan limitations for infusion procedures
- Assists in telephone inquiries and written inquiries from patients regarding their insurance approval process
- Manages outsourcing of out of network referrals and optimizes 340B opportunity impact
- Reviews medical necessity and diagnosis prior to procedures being done and conferences other HCPs as needed
- Direct liaison to specialty pharmacy & home infusion billers and payers to ensure correct billing function and collections
- Assist in securing copay assistance programs and grant funding for eligible patients by disease state
- Responsible for training staff in financial counseling
- Drafts and compiles patient education materials and provider marketing materials
- Adheres to NMHS/NMMC Policies/Procedures/Guidelines
- Complies with applicable Local/State/Federal policies/procedures/guideline/regulations/laws/statues
- Assist with compliance to 340B/JCAHO/URAC/ACHC requirements
Patient Care:
- Assesses educational needs and deficits to improve patient compliance
- High School Diploma or equivalent; Also required: Associate's Degree in Business ,Coding, related field OR a certified pharmacy technician; required (CPhT or other) with minimum 2 years' experience with insurance benefit coordination, OR a BA or BS degree with prior pharmacy business experience, retail or specialty pharmacy preferred, financial clearance, insurance experience
- Strong verbal and written communication skills; required
- Must possess excellent customer service skills and problem solving abilities
- Must possess strong organizational and interpersonal skills
- Must possess strong independent work skills
- Strong interpersonal skills; required