Referral Coordinator - Ambulatory Pharmacy

Prime Healthcare•Olympia Fields, IL

14h•Onsite

About The Position

The Ambulatory Medication Access and Referral Coordinator provides expert-level support to the Prime Healthcare Ambulatory Services Team. This support will span all advanced complex aspects of ambulatory pharmacy workflows including, but not limited to, referral review and processing, patient scheduling, maintaining accurate data records of activities and outcomes, and evaluating patient’s insurance to assist with medication access. The position participates in implementing medication access workflows for newly established ambulatory pharmacy service departments and validating maintenance of medication access workflows at existing ambulatory pharmacy service departments. This position serves as a liaison between providers, pharmacies, insurance carriers, and patients to streamline medication access, reduce financial barriers, and support continuity of care. This position independently manages and strategically evaluates patient referrals for Ambulatory Care services to determine appropriateness of referral, collaborates with referring provider(s) for information clarifications, and conducts patient outreach and interviews to obtain additional information and scheduling, as appropriate. The Ambulatory Medication Access and Referral Coordinator is also responsible for maintaining accurate records within the electronic medical record (EMR) of all activities performed to ensure excellent coordination of care. The Ambulatory Medication Access and Referral Coordinator must have comprehensive expertise in prior authorization management, including expertise with all insurance types, specialty medication access, and financial assistance coordination within ambulatory care settings. This position must be proficient with the requirements of the 340b program and ensure all prescriptions are going through the necessary steps to qualify for this program. The Ambulatory Medication Access and Referral Coordinator must be knowledgeable on financial assistance including pharmaceutical foundation programs, manufacturer copay assistance cards, and internal medication assistance processes. Depending on the acuity of medication access or referrals, the coordinator will also review each case with the Ambulatory Pharmacy Technician Supervisor or overseeing pharmacist, as appropriate, to avoid gaps in care. This position serves as a subject matter expert and uses independent discretion and judgement in prioritizing their workflow, managing patient problems, and ensuring all patients receive their medications in a timely manner. This position ensures proper, efficient insurance authorization, answers financial questions from patients and providers, and documents authorization outcomes to guide optimal, timely medication access. This position manages uninsured and underinsured patient referrals to ensure enrollment in patient assistance and other charity options as available. This position serves as a subject matter expert and key operational resource to clinical leadership, providers, and prior authorization coordinators.

Requirements

High school diploma or equivalent required
Current State of IL pharmacy technician license in good standing
Certified Pharmacy Technician (CPhT) credential
Minimum 3 years of experience in ambulatory care, specialty pharmacy, or 340B settings
Proficiency in electronic medical record (EMR) systems and insurance authorization platforms.
Knowledge of HIPAA regulations and patient confidentiality standards.

Nice To Haves

Working knowledge of pharmaceutical foundation assistance programs and manufacturer co-pay card enrollment processes.
Experience qualifying and processing patients under 340B drug pricing program guidelines.
Strong understanding of commercial, Medicare, and Medicaid insurance plans and formulary requirements.
Experience coordinating patient outreach and scheduling in a high-volume clinical setting
Excellent communication skills with the ability to collaborate effectively with providers, pharmacies, payers, patients, and external offices.
Strong organizational skills with the ability to manage multiple cases and meet deadlines in a fast-paced environment.

Responsibilities

Provides expert-level support to the Prime Healthcare Ambulatory Services Team, spanning complex aspects of ambulatory pharmacy workflows.
Reviews and processes referrals, schedules patients, and maintains accurate data records of activities and outcomes.
Evaluates patient insurance to assist with medication access.
Participates in implementing and validating medication access workflows for new and existing ambulatory pharmacy services.
Serves as a liaison between providers, pharmacies, insurance carriers, and patients to streamline medication access, reduce financial barriers, and support continuity of care.
Independently manages and evaluates patient referrals for Ambulatory Care services, determining appropriateness and collaborating with referring providers.
Conducts patient outreach and interviews to obtain additional information and scheduling.
Maintains accurate records within the electronic medical record (EMR) of all activities performed.
Possesses comprehensive expertise in prior authorization management, including all insurance types, specialty medication access, and financial assistance coordination.
Proficient with the requirements of the 340b program and ensures prescriptions qualify.
Knowledgeable on financial assistance programs, including pharmaceutical foundation programs, manufacturer copay assistance cards, and internal medication assistance processes.
Reviews cases with Ambulatory Pharmacy Technician Supervisor or overseeing pharmacist as needed.
Serves as a subject matter expert and uses independent discretion and judgment in prioritizing workflow, managing patient problems, and ensuring timely medication access.
Ensures proper and efficient insurance authorization, answers financial questions, and documents authorization outcomes.
Manages uninsured and underinsured patient referrals to ensure enrollment in patient assistance and charity options.
Serves as a key operational resource to clinical leadership, providers, and prior authorization coordinators.