Specialty Pharmacy Navigator (Per Diem)

Cape Cod Healthcare•Hyannis, MA

About The Position

Establishes and maintains effective relationships with the healthcare team and patient. Exemplifies excellent customer service during interactions with patients, employees, providers and others to build the Specialty Pharmacy program. Holds the primary responsibility of navigating specialty pharmacy prescriptions from the introduction to the patient to the delivery of the specialty medication. Integrate with patients, physicians, nurses, pharmacists, and other health care professionals to ensure that assigned Specialty Pharmacy patient receives the medications he/she needs at the appropriate time. Interface and problem solve, if needed, with the referring provider and/or clinic staff; monitors satisfaction of patients. Represent on-site/off-site Specialty Pharmacy seamlessly, answer patient and provider staff questions about the service, insurance issues, deliveries, and any other related subject. Initiate call to pharmacist for intervention when appropriate. Expedites the prescription filling process (entering patient demographics, allergies, insurance information); obtain benefit information, verify patient insurance eligibility and level of coverage; understand Medicare/Medicaid regulations and billing guidelines as they pertain to Specialty Pharmacy patient benefits; understand billing primary, secondary and tertiary insurance claims. Process medication orders confirming that they are billed to all third parties correctly. Initiate and assist with the Prior Authorization and Patient Prescription Financial Assistance processes within the assigned therapy classes; resolve billing issues and obtain Prior Authorizations for medications when needed. Work with Patient Financial Advocates regarding ongoing coverage levels/issues; provide education and training as necessary or instructed. Establishes relationships with other specialty pharmacies to provide care out of network when appropriate. Assist in marketing efforts to enhance business and increase revenue and patient retention by understanding Specialty Pharmacy business, trends, marketing materials and business expectations. Assist Pharmacy Manager with tasks to improve processes to facilitate communications and service between patient, clinic and Specialty Pharmacy teams to ensure accurate and timely delivery of all medications. Maintain patient education materials, collect data, run statistics and monitor productivity. R etrieval of prescriptions from patients; data and prescription entry; prescription filling and packaging , general phone/customer service involving refills and resolving insurance issues; working the cash register Works collaboratively with members of the healthcare multi-disciplinary team and communicates effectively with departmental staff and patient. Performs other work related duties as reasonably requested/directed.

Requirements

Current Massachusetts Pharmacy Tech License
Minimum one year of related healthcare experience
Ability to develop effective working relationships with medical team
Ability to communicate clearly and effectively in person, in writing or by phone
Familiarity and ability to work with diversity of cultural/socio-economic background
Proficiency with computers and most commonly used Microsoft programs

Nice To Haves

Pharmacy Technician Certification Board (PTCB) Certification or equivalent within 1 year of hire
Familiarity with Specialty Pharmacy resources preferred
Understanding Medicare/Medicaid regulations and billing guidelines as they pertain to Specialty Pharmacy patient benefits

Responsibilities

Navigating specialty pharmacy prescriptions from introduction to delivery.
Integrating with healthcare professionals to ensure patients receive medications at the appropriate time.
Interfacing and problem-solving with referring providers and clinic staff; monitoring patient satisfaction.
Representing the Specialty Pharmacy, answering questions about service, insurance, and deliveries.
Initiating calls to pharmacists for intervention when appropriate.
Expediting the prescription filling process (entering patient demographics, allergies, insurance information).
Obtaining benefit information, verifying patient insurance eligibility and level of coverage.
Understanding Medicare/Medicaid regulations and billing guidelines.
Processing medication orders and ensuring correct billing to third parties.
Initiating and assisting with Prior Authorization and Patient Prescription Financial Assistance processes.
Resolving billing issues and obtaining Prior Authorizations for medications.
Working with Patient Financial Advocates regarding coverage levels/issues; providing education and training.
Establishing relationships with other specialty pharmacies for out-of-network care.
Assisting in marketing efforts to enhance business and increase revenue and patient retention.
Assisting Pharmacy Manager with tasks to improve processes and communication.
Maintaining patient education materials, collecting data, running statistics, and monitoring productivity.
Retrieving prescriptions from patients; data and prescription entry; prescription filling and packaging.
Providing general phone/customer service involving refills and resolving insurance issues.
Working collaboratively with the healthcare team and communicating effectively with staff and patients.
Performing other work-related duties as requested.