Medication Access Coordinator - Medical Billing

The Nebraska Medical Center•Omaha, NE

4d•Remote

About The Position

Serious Medicine is what we do. Being extraordinary is who we are. Every colleague plays a key role in upholding this promise to our patients and their families. Medication Access Coordinator - Medical Billing: Determine, support, and assist patients, provider teams, and the pharmacy department to overcome barriers to medication access, with focused expertise in third party prior authorization and billing processes for pharmacy benefits. Assist patients within enrollment into grants, assistance programs, and communicate any financial responsibilities. Provide a Face-to Face/virtual beside oriented service that delivers comprehensive fiscal options to patients. Gather and effectively communicate medical and medication histories including diagnosis, test results, lab values, and previous medications to third party. Verify eligibility, pharmacy benefit provisions and support the appeals process.

Requirements

Minimum of 3 years’ experience in retail/specialty pharmacy insurance or payer systems (Medicaid, Medicare, or private insurance)
Minimum of three years healthcare and/or insurance/third party reimbursement experience.
High school education or equivalent required.
Excellent interpersonal skills and the ability to successfully interact with a variety of internal and external customers at all levels required.
Ability to solve problems independently and must be strongly vested in team management required.
Ability to multi-task and excel in a dynamic environment required.
Experience with various computer mainframe, network, web based and payer applications required.
Must register with the State of NE as a pharmacy technician required.
Must complete Pharmacy Technician Certification within one year required.

Nice To Haves

Home infusion experience
Familiarity with CPR+ or CareTend software
Strong problem-solving and patient advocacy skills
Detail orientation with excellent documentation and follow-up
Knowledge of commercial, Medicare B, Medicare D, and Medicaid pharmacy rules and regulations preferred.
Associate's degree in business, healthcare or related field preferred.
Bi-lingual preferred.
Prior Authorization experience in specialty or retail pharmacy preferred.
340B knowledge and experience preferred.
Apexus 340B OnDemand Certificate preferred.
One year of pharmacy technician experience preferred.

Responsibilities

Conduct home infusion medical billing benefit investigations
Complete prior authorizations and insurance appeals
Remove medication access barriers and support patients with coverage needs
Apply expertise in DME billing, payer-specific infusion coverage guidelines, and home infusion services
Document and follow up in a fast-paced, desk-based environment
Determine, support, and assist patients, provider teams, and the pharmacy department to overcome barriers to medication access, with focused expertise in third party prior authorization and billing processes for pharmacy benefits.
Assist patients within enrollment into grants, assistance programs, and communicate any financial responsibilities.
Provide a Face-to Face/virtual beside oriented service that delivers comprehensive fiscal options to patients.
Gather and effectively communicate medical and medication histories including diagnosis, test results, lab values, and previous medications to third party.
Verify eligibility, pharmacy benefit provisions and support the appeals process.