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Specialist - Pharmacy Reimbursement: Miramar O/P Pharmacy

Company: Memorial Healthcare System
Location: Miramar
Posted on: August 28, 2020

Job Description:

Job Description: Summary: Responsible for performing investigation of pharmacy benefit coverage, identifying prior authorizations, helping patients with financial assistance, and initiating support for denied prior authorizations. Coordinates enrollment in the patient assistance program to ensure compliance. Responsible for producing reports on monthly pharmaceutical savings. Detailed responsibilities: --- Improve access to pharmaceutical therapy by performing pharmacy benefit investigation, copay assistance, or enrollment in manufacturer free drug programs as appropriate. --- Perform pharmacy benefit investigation and apply knowledge and understanding of the coverage rules by third party and CMS. Identify therapies that require prior authorizations, copay assistance, or certificate of medical necessity and work with providers to obtain approval. Initiate support for appeals to denied prior authorizations for pharmacy services. --- Assist patients that require financial assistance for pharmacy services. Contact pharmaceutical companies to obtain information and enroll patients into pharmaceutical patient assistance program. Assesses patient eligibility for enrollment into patient assistance programs, enrolls qualifying patients and reclassify accounts when appropriate. --- Coordinate delivery of free drug replacement for patient treatment and reclassify accounts when applicable. Coordinate the reception and distribution of reimbursement bulk merchandise. Ensure compliance with financial and regulatory requirements. --- Develop reimbursement payments schedules for patients with special needs. Track status of expiring reimbursements and process renewals as appropriate. --- Participate in pharmacy reimbursement initiatives that increase patient access to pharmaceutical services and promote cost savings to the health system. 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. --- INSURANCE VERIFICATION: Verifies and enters insurance information and authorization/referral requirements. --- PROBLEM SOLVING: Ability to identify, analyze and effectively solve problems. --- PATIENT AND FAMILY CENTERED CARE: "Provides Patient and Family Centered Care to patients, families, visitors and internal customers" --- THIRD PARTY AUDITS: Utilizes knowledge of healthcare industry audit processes conducted by external organizations or agencies to improve quality of service. Education: Essential: --- High School Diploma or Equivalent Credentials: Essential: --- Registered Pharmacy Technician - FL 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: Minimum 3 years of experience. Proficient understanding of the delivery of healthcare across multiple service lines including physician practices, ancillary services, infusion suites, and pharmacy services. Organizational Profile: When the City of Miramar was founded back in 1955, fewer than 200 people lived there. Today, it's home to 200,000 residents who can call upon Memorial Hospital Miramar when they need outstanding compassionate care. With 178 beds, Memorial Hospital Miramar includes 162 acute-care beds, a 16-bed Level II NICU, and The Family Birthplace, which has welcomed nearly 30,000 babies into the world since the hospital opened in 2005. Services also include: --- Cardiac Telemetry Unit --- Imaging Services --- Intensive Care --- Women's Services --- Adult and Pediatric Emergency Departments --- Joe DiMaggio Children's Hospital Pediatric Therapy Services --- [U18] Sports Medicine for athletes 18 and younger --- Memorial Rehabilitation Institute Memorial Hospital Miramar has been named by Truven Health Analytics and Modern Healthcare magazine as one of the nation's 100

Keywords: Memorial Healthcare System, Hollywood , Specialist - Pharmacy Reimbursement: Miramar O/P Pharmacy, Other , Miramar, Florida

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