Pharmacy Clerk

The US Oncology Network•Antioch, CA

23h•$26 - $32

About The Position

Under general supervision, reviews chemotherapy regimens in accordance to reimbursement guidelines. Obtains necessary pre-certifications and exceptions to ensure no delay in reimbursement of treatments. Researches denied services and alternative resources to pay for treatment. Supports and adheres to the US Oncology Compliance Program, to include the Code of Ethics and Business Standards.

Requirements

High School degree or equivalent requred
Minimum three (3) years medical insurance verification and authorization required

Responsibilities

Reviews, processes and audits the medical necessity for each patient chemotherapy treatment and documentation of regimen relative to pathway adherence
Communicates with nursing and medical staff to inform them of any restrictions or special requirements in accordance with particular insurance plans.
Provides prompt feedback to physicians and management regarding pathway documentation issues, and payer issues with non-covered chemotherapy drugs.
Communicates with Patients, Insurances and Pharmacies for any prior authorization needs.
Tracks pathways and performs various other business office functions on an as needed basis
Obtains insurance authorization and pre-certification specifically for chemotherapy services. Works as a patient advocate and functions as a liaison between the patient and payer to answer reimbursement questions and avoid insurance delays.
Researches additional or alternative resources for non-covered chemotherapy services to prevent payment denials.
Maintains a good working knowledge of chemotherapy authorization requirements for all payers, State and federal regulatory guidelines for coverage and authorization.
Adheres to confidentiality, state, federal, and HIPPA laws and guidelines with regards to patients records
Other duties as requested or assigned.