Specialty Pharmacy Program Coordinator

Cape Cod Healthcare•Hyannis, MA

About The Position

The Specialty Pharmacy Program Coordinator plays a crucial role in managing and optimizing the specialty pharmacy program. This position involves reporting on program outcomes, facilitating reimbursement processes, assisting with marketing to enhance business and patient retention, and maintaining patient education materials. The coordinator is responsible for data collection, statistical analysis, and monitoring productivity. They also train new employees and students, stay current with pharmacy trends, and serve as a reliable resource for specialty medications and pharmacy benefits. Key responsibilities include assisting with department scheduling, performing other assigned duties, and collaborating with patients, nursing staff, pharmacy personnel, prescribers, and other care team members to ensure patients receive necessary medications on time. The role involves representing the specialty pharmacy service both on-site and off-site, addressing inquiries about services, insurance, and deliveries, and initiating pharmacist intervention when needed. Establishing relationships with other specialty pharmacies for out-of-network care and coordinating patient treatment needs with facility staff are also important aspects. The coordinator participates in all prescription processing workflow activities, including patient chart creation, prescription retrieval, data entry, billing, insurance issue resolution, filling and packaging, customer service, and cash register operations. Ensuring accurate prescription billing involves obtaining patient benefit information, verifying insurance eligibility and coverage, understanding Medicare/Medicaid regulations, and managing primary, secondary, and tertiary insurance claims. The role also includes expediting therapy initiation by preparing prior authorizations, communicating insurance requirements to providers, and providing daily follow-up on prescriptions awaiting authorization. Facilitating refill reminders, patient consultations with pharmacists, and working with Patient Financial Advocates on coverage issues are also part of the duties. The coordinator acts as a liaison with pharmacy benefit managers for timely prescription delivery, performs on-call duties, operates inventory devices, and assists with periodic inventories and returns processing. Finally, they support the Pharmacy Manager in improving processes to enhance communication and service between patients, clinics, and specialty pharmacy teams for accurate and timely medication delivery.

Requirements

High School Diploma or GED
Ability to read, write and Communicate in English
Currently licensed as a Pharmacy Technician in the Commonwealth of Massachusetts
Current certification with the Pharmacy Technician Certification Board or equivalent
4 years pharmacy experience
Demonstrated ability to work independently with limited supervision and demonstrates goal-oriented thinking, leadership ability, and strong interpersonal, operational, and organizational skills
Good computer and analytical skills are required. Must have good understanding of Microsoft Excel.
Must be detail oriented.
Ability to develop effective working relationships with medical team.
Ability to communicate clearly and effectively in person, in writing or by phone.

Nice To Haves

Familiarity with Specialty Pharmacy resources preferred.
Familiarity and ability work with diversity of cultural/socio-economic backgrounds.

Responsibilities

Reports monthly to management on program outcomes.
Facilitates a reimbursement program to minimize losses related to inefficiencies.
Assists in marketing efforts to enhance business and increase revenue and patient retention by understanding Specialty Pharmacy business, trends, marketing materials and business expectations.
Maintains patient education materials, collects data, runs statistics, and monitors productivity.
Trains and orients new employees and students on procedures and operations of the department.
Stays current with pharmacy trends.
Is a reliable/trusted resource and leader regarding specialty medication and pharmacy benefits.
Assists in scheduling for the department.
Assists Management and performs other work-related duties as assigned or requested.
Works cooperatively with patients, nursing, pharmacy, prescribers, and other patient care team personnel to ensure that assigned Specialty Pharmacy patients receive the medications they need at the appropriate time.
Represents on-site/off-site Specialty Pharmacy seamlessly, answers patient and provider/staff questions about the service, insurance issues, deliveries, and any other related subject. Initiates call to pharmacist for intervention when appropriate.
Establishes relationships with other specialty pharmacies to provide care out of network when appropriate.
Coordinates patient treatment needs with appropriate facility staff.
Participates in all prescription processing workflow activities, including but not limited to patient chart creation (demographics, allergies, insurance information), retrieval of prescriptions from patients and prescriber offices, data entry, billing, resolution of insurance issues, filling and packaging, general phone/customer service involving refills, and working the cash register.
Ensures appropriate prescription billing, including obtaining patient benefit information, verifying insurance eligibility and level of coverage, understanding Medicare/Medicaid regulations and billing guidelines as they pertain to Specialty Pharmacy patient benefits, and understanding primary, secondary and tertiary insurance claim processing.
Expedites initiation of therapy by preparing prior authorizations for nurse/provider review and completion. Communicates insurance information regarding unique coverage requirements to providers and nurses as it applies to certain situations.
Provides daily follow up on any prescriptions waiting for prior authorizations.
Facilitates refill reminders and patient consultation with a Pharmacist when requested by the patient.
Works with Patient Financial Advocates regarding ongoing coverage levels/issues; provides education and training as necessary or instructed.
Acts as a liaison between pharmacy benefit managers to ensure appropriate and timely prescription delivery.
Performs on call duty.
Operates handheld inventory device and participates in periodic inventories. Processes and tracks returns to reverse distributor and wholesaler.
Assists Pharmacy Manager with tasks to improve processes to facilitate communication and service between patient, clinic, and Specialty Pharmacy teams to ensure accurate and timely delivery of all medications.