Pharmacy Patient Specialist or Pharmacy Medication Access Specialist

About this role

Location:

Integrated Services Center Worker Type: Regular Work Shift: Day Shift (United States of America) Pay Range: The pay range for this position is listed below. Actual pay rate dependent upon experience. $20.75 - $31.25 Position Highlights *May be eligible for a $3,000-$4,000 sign-on bonus!*

*This position will be located at the Yankton Medical Clinic*

A Brief Overview

Works proactively with pharmacy patients to provide comprehensive financial planning and financial advocacy. Responsible for prescription insurance verification, prior authorizations and compassionate care medication programs. Works to reduce access and financial barriers to medications for patients. Provides superior customer service; facilitates third party and patient billing for pharmacy patients. Provides problem solving for patients and internal customers. Need working knowledge of insurance, Medicare and basic accounting principles. Able to deal with phone conversations, correspondence, or direct contact with people about billing issues. Coordinates work flow with other members of the healthcare team to ensure a productive and efficient environment.

What you will do   • Investigates patient insurance benefits and other supplemental payer information to maximize prescription medication funding and minimize out of pocket expenses. • Investigates alternate funding from non-profit foundations or manufacturer sponsored compassionate care programs. • Initiates and monitors prior authorizations. Assists providers in appeal submission and follow-up. • Maintains communication with health care providers, pharmacy benefit managers and pharmacy patients to ensure timely delivery of medications. • Assists with the collection and maintenance of records as needed by the Pharmacy department, Joint Commission accreditation, OSHA guidelines, and other accreditation as may be required by law, practice standards or departmental policy. • Works closely with pharmacy staff to assure compliance with all applicable accreditations standards and State and Federal requirements and regulations. • Works directly with un-insured or underinsured patients to review and enroll them in appropriate Patient Assistance Program(s). • Works directly with manufacturers as well as through national foundations and peer professional relationships to determine companies that offer Patient Assistance Programs and develop strategies to maximize such participation.

Essential Qualifications

The individual must be able to work the hours specified. To perform this job successfully, an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others, hear, understand and distinguish speech and other sounds. These requirements and those listed above are representative of the knowledge, skills, and abilities required to perform the essential job functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions, as long as the accommodations do not cause undue hardship to the employer.

Required Education, License/Certification, or Work Experience:   • High School or GED Equivalent or one to three months related experience and/or training; or equivalent combination of education and experience

Preferred Education, License/Certification, or Work Experience:   • 1-3 years experience as a pharmacy technician • experience with medical/health insurance claims and/or social work

Expectations and Standards   • Commitment to the daily application of Avera’s mission, vision, core values, and social principles to serve patients, their families, and our community. • Promote Avera’s values of compassion, hospitality, and stewardship. • Uphold Avera’s standards of Communication, Attitude, Responsiveness, and Engagement (CARE) with enthusiasm and sincerity. • Maintain confidentiality. • Work effectively in a team environment, coordinating work flow with other team members and ensuring a productive and efficient environment. • Comply with safety principles, laws, regulations, and standards associated with, but not limited to, CMS, The Joint Commission, DHHS, and OSHA if applicable.

You Belong at Avera

Be part of a multidisciplinary team built with compassion and the goal of Moving Health Forward for you and our patients. Work where you matter.

A Brief Overview

Works proactively with pharmacy patients to provide comprehensive financial planning and financial advocacy. Responsible for prescription insurance verification, prior authorizations and compassionate care medication programs. Works to reduce access and financial barriers to medications for patients. Provides superior customer service; facilitates third party and patient billing for pharmacy patients. Secures pharmacy patient accounts to ensure payment of medications; provides problem solving for patients and internal customers. Need working knowledge of insurance, Medicare and basic accounting principles. Able to deal with phone conversations, correspondence, or direct contact with people about billing issues. Coordinates work flow with other members of the healthcare team to ensure a productive and efficient environment.

What you will do

• Understands the process of insurance verification and online prescription adjudication.

• Investigates patient insurance benefits and other supplemental payer information in order to maximize prescription medication funding and minimize out of pocket expenses.

• Investigates alternate funding from non-profit foundations or manufacturer sponsored compassionate care programs.

• Initiates and monitors prior authorizations.

• Maintains communication with health care providers, pharmacy benefit managers and pharmacy patients in order to ensure timely delivery of medications.

• Performs clerical/billing functions associated with the medication distribution system.

• Accurately

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