Patient Intake Coordinator – Specialty Pharmacy (Per Diem)

Boston Medical Center•Boston, MA

32d

About The Position

Working as a drug access liaison specialist, this role supports patients, caregivers, providers, and pharmacies in navigating insurance benefits for all medications administered in hospital clinics, infusion centers, and/or home settings. The drug access liaison specialist must understand how to navigate payer medical benefits policies and procedures to ensure patients appropriately receive their prescribed injectable therapies. This person needs to have a strong understanding and ability to identify patient medical information, interpret medical terminology, and possess knowledge of medical billing coding in three areas: provider, home infusion, and hospital billing. Under the direct supervision of the Manager of Drug Access, this person will identify patient insurance benefits, submit all required medical documentation to the payer for approval, and assist the patient in accessing the drug through the most appropriate site of care.

Requirements

High school Diploma or equivalent is required.
At least five years of experience working with insurance companies on appropriate billing for private or third party reimbursement, managed care, or clinical support.
Knowledge of private payer, Medicare and Medicaid structure, and specialty pharmacy and retail pharmacy processes.
Knowledge of operational processes within a physician’s office and/or infusion center, specifically related to prior authorizations.
Ability to communicate reimbursement and access topics concisely and clearly to provider staff.
Reviewing patient insurance benefit options and validating prior authorization requirements.
Identifying alternate funding/financial assistance programs.
Coordinating with hospital patient support services programs representatives.
Proven ability to collaborate and work in teams to achieve results in a complex, fast-paced service environment.
Excellent English oral and written communication skills.
Ability to communicate professionally over the phone.
Excellent interpersonal skills to provide superb personalized customer service and to instill confidence and to advocate for patients.
Ability to explain required information to customers in a comprehensible manner.
Proactive demeanor, independently problem solve, organized, detail oriented, ability to self-direct through multitasking and prioritizing, dependable, empathetic, focused on quality service, goal-oriented.
Cultural sensitivity, understanding, and comfort with various social, racial, and ethnic populations.
Must practice discretion and confidentiality as the position deals with highly sensitive and private data.
Ability to understand, explain, and actively promote the hospital’s objectives through direct coordination and commitment to the program’s goals.
Flexibility to adapt to changes in departmental needs, including offering assistance to other team members, adjusting assignments, etc.
Highly proficient in Microsoft Office, particularly Excel, Word, and Outlook.
Ability to quickly learn other relevant applications that support patient care management and assigned responsibilities; and ability to extract necessary information.

Nice To Haves

Associate or Bachelor’s degree.
Pharmacy Technician National Certification.
Experience within a healthcare setting, such as a physician practice, patient assistance program, or similar pharmaceutical/biological support program.

Responsibilities

Understand basic clinical skills related to medical terminology and coding for different disease states or medical conditions.
Communicate effectively with carrier representatives, patients, and providers.
Comprehensively review patient insurance benefits to navigate drug access barriers.
Understand major medical policies as they relate to site of care, medical necessity, and pharmacy benefits.
Triage and coordinate patients to the appropriate site of care to ensure accurate prescription and prompt drug delivery.
Understand drug access through hospital, home infusion, and pharmacy points of access.
Review patient medical information through the hospital’s electronic medical records.
Liaise with patient’s relevant health care providers to support patient’s access to therapy and support services.
Gather medical information and submit timely prior authorization for medications based on payer medical policies.
Oversee all authorizations and benefits related to medications administered by a healthcare provider.
Understand prior authorization requirements, including dates of expiration and maximum units/doses.
Gather and assist in the management of data reports related to reimbursement and drug access services.
Identify and understand medical coding billing errors.
Provide assistance to management for all payer audits, collect and distribute pertinent patient information.
Have a strong understanding of Medicare payment policies.
Screen patients for medical necessity based on Medicare LCD and NCD requirements.
Support the Drug Access Hub as needed.
Refer patients to the pharmacy Financial Assistance Team when appropriate.
Multitask and complete multiple projects on time.
Establish milestones and checkpoints to ensure successful work/project completion; follow up on work efforts and take corrective steps when needed.
Adhere to all of BMC’s RESPECT behavioral standards.