Pharmacy Care Coordinator

Children's Hospital of Philadelphia•King of Prussia, PA

1d•Onsite

About The Position

The Pharmacy Care Coordinator is responsible for obtaining prior authorization, facilitating patient access to medication, and coordinating patient care, including documentation, dispensing, and distribution under the supervision of a licensed pharmacist. This role ensures compliance with regulatory and accrediting agency requirements. Key responsibilities include managing medication authorizations to optimize patient access to therapy, answering calls, verifying covered and non-covered medications, explaining benefits structures, and conducting necessary follow-up with families, providers, and payors regarding referral issues, authorization questions, insurance eligibility, copay assistance programs, and medication delivery. The Pharmacy Care Coordinator will also cross-cover other areas as needed.

Requirements

High School Diploma / GED
At least two (2) years relative job experience
Ability to work with stressful situations
Strong interpersonal, communication and organizational skills
Ability to function efficiently and professionally with minimum of supervision.
Ability to quickly learn new procedures.
Strong computer skills.
Ability to juggle multiple insurance issues.
Strong customer service skills
Ability to display compassion and empathy
Mandatory required training within first 30 days: Website Insurance Training (Navinet, WebMD, Passport)
Mandatory required training within first 30 days: EPIC training & testing (Prelude/Cadence).
Mandatory required training within first 30 days: Registration Essentials
Mandatory required training within first 30 days: Pharmacy systems training

Nice To Haves

Bachelor's Degree
Pharmacy Insurance background preferred
EPIC registration experience preferred
Background in medical terminology preferred

Responsibilities

Provides information of Pharmacy benefit structures to patients/caregivers, clinical team and physicians
Performs eligibility verification
Manages authorizations
Communicates expected out-of-pocket costs and copay assistance programs
Introduces and explains scope of Pharmacy services to the patient/caregiver to include: medication history, refill coordination, access to emergent services, and pharmacist escalation as appropriate.
Provides customer service when answering incoming patient calls, communicating with patients on urgent requests, and communicating with medical/nursing staff to obtain key information needed
Assists with coordinating and scheduling the prescription delivery process.
Prepares new and refill prescriptions accurately, through the proper use of equipment and techniques, based on CHOP Policy for prescription entry and dispensing.
Participates in departmental process improvement initiatives.
Follows up with insurance companies and families of patients identified as ineligible or non-covered
Contacts family and/or responsible party, as necessary, to inform them of any insurance problems or restrictions, ensuring that insurance information is clearly relayed to and understood by family and/or responsible party.
Contacts clinical office with all information that requires follow-up.
Performs other duties as assigned by Pharmacy Management.
Create and/or update patient record by verifying demographic, insurance information, or proper study identification in the registration system
Ensure specific registration fields are accurately inputted into registration system, including but not limited to visit notes, referral/authorization numbers, eligibility review, proper payor plan entries for research and standard-of-care visits
Verify coverage through third party benefit coverage/authorization vendors.
Educate and inform family of outstanding financial obligations if appropriate.
Electronically collect or facilitate payment of outstanding balances.