Pharmacy Access Rep III - DME

The Pharmacy Access Representative III (PAR) is responsible for the overall management of medical equipment and supplies, coverage determination, and removal of barriers that prevent patients from receiving their equipment. Duties will include insurance coverage verification and determination, patient cost estimation, assembly of documentation necessary to ensure payment for equipment in compliance with payer standards. The PAR will communicate with the prescriber’s office to acquire necessary information to submit claims to the patient’s insurance for approval including prior authorization and helping educate patients with financial need and arrange timely delivery of the equipment. The PAR will link communication between the patient, referral source, insurance, and staff to ensure coordinated care.

Responsibilities

Manage medical equipment and supplies, coverage determination, and removal of barriers preventing patients from receiving equipment; Verify and determine insurance coverage; Estimate patient costs; Assemble documentation necessary to ensure payment for equipment in compliance with payer standards; Communicate with prescriber’s office to acquire necessary information to submit claims; Manage prior authorization; Educate patients with financial need and arrange timely delivery; Link communication between patient, referral source, insurance, and staff; Coordinate Home Medical Equipment (HME) and supplies referrals and delivery; Maintain expertise on insurance coverage and requirements for home medical equipment; Ensure compliance and quality; Perform other related duties as required

Requirements

At least 18 years of age at the time of application; Associate’s degree in a Medical, Secretarial, or related field and 4 years of relevant experience; Or equivalent combination of education and experience; Capable of working independently with minimum supervision; Strong communication skills, problem-solving abilities, and professional presentation; Customer relations skills; Ability to multi-task, manage many details with accuracy, work under pressure, and maintain a professional attitude

Nice to have

Completed 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