Pharmacy Access Rep III - Home Infusion

The Pharmacy Access Representative III (PAR) is responsible for the overall financial management and coordination for home infusion referrals including removal of barriers that prevent patients from receiving their medications. Duties will include insurance coverage determination, patient out of pocket determination, determination of prior authorization requirements. The PAR will communicate with the prescriber’s office to acquire necessary information and assembly of documentation necessary to submit claims to the patient’s insurance for approval including prior authorization and helping enroll patients in financial assistance programs. The PAR will link communication between the referral source, patient, pharmacy, insurance, and staff to ensure coordinated care.

Responsibilities

Coordinate medication and supplies coverage with referral sources and pharmacy staff to ensure timely financial approval; Act as liaison between home care coordinators, hospital discharge coordinators, home infusion staff and providers to obtain accurate information for home infusion billing; Determine insurance coverage and patient out of pocket costs; Obtain and assemble documentation for insurance claims and prior authorization; Enroll patients in financial assistance programs; Communicate with prescriber's office and patients; Maintain expertise on insurance coverage and patient assistance programs; Manage prior authorization requests; Monitor and reconcile patient self-pay accounts; Ensure compliance with confidentiality and quality improvement initiatives; Assist with training of new team members

Requirements

At least 18 years of age at the time of application; Associate’s degrees in Medical, Secretarial, or related field or equivalent combination of education and experience; Minimum of four years of relevant experience or equivalent combination of education and experience; Capable of working independently with minimum supervision; Exhibit strong communication skills, problem-solving abilities, and a professional presentation; Demonstrate customer relations skills; Individual must be able to multi-task, manage many details with accuracy, work under pressure, and maintain professional attitude

Nice to have

Complete ASHP accredited training program or equivalent experience as a pharmacy technician; Certification from a nationally accredited pharmacy technician certification program (Currently PTCB) and maintain ongoing education requirements