Specialty Pharmacy Financial Access Coordinator, Lead Mount Sinai Health System Full Rime Days

Description

Under direct supervision of the Director of Specialty Pharmacy the Specialty Pharmacy Manager and the Specialty Pharmacy Clinical Liaison the Specialty Pharmacy Access Coordinator Lead supervises Financial Access Coordinator staff and interacts with clinical employees on multiple levels including pharmacists nurses medical/clinical staff Finance personnel department managers access services staff and Billing Assistants. External contacts may include third party payers accrediting bodies insurance /PBM companies government peer review organizations accrediting bodiesexternal partners and referring physicians. The relationships are inherent to the success of this position. The Lead is primarily responsible for but not limited to oversight of staff responsible for the prompt attention to prior authorization of specialty medications oversight of the quality of work done in key department systems support of medical staff assistance in obtaining financial support for patients and timely communication with medical providers including mail correspondence messaging telephone correspondence and EHR documentation.

the duties of subordinate technical and clerical personnel including less experienced Specialty Financial Pharmacy Access Coordinators and billers.

thorough documentation on all authorization requests prescription verifications and other data by facility.

supervising Pharmacists.

manages and directors in the training and mentoring of new pharmacy personnel; nurtures a teamwork environment.

meets with and manages vendors and pharmaceutical manufacturers.

facilitates and reviews departmental projects initiatives and partner programs

with department pharmacists and administrators to design administer and support quality assurance and related tasks

and reviews work in all key department systems (dispense clinical management EMR)

and presents reports and analytics as requested.

and evaluates outpatient take-home prescriptions and determines feasibility of processing through patient and payer-preferred specialty pharmacy and if not coordinates service with the correct pharmacy group.

prior authorizations from intermediaries and payers including managed care companies insurance companies or others as appropriate. Ensures completion of activities that maximize revenue capture for high-cost medications.

a high level of customer service by the completion of applications including those for the Patient Assistance Program (PAP) and co-pay assistance.

with medical and professional staff on a case by case basis to obtain appropriate clinical documentation to ensure accurate indications in the patients medical record before completion of third party authorization. This may include contacting referring physicians for information.

with appropriate individuals (i.e. patient providers and pharmacy staff) regarding outcomes of prior authorizations and responds to complex questions from third party payers and clinical staff regarding medication-related issues and reimbursement.

approved prescriptions through the pharmacy software system or begins the appeal process for denied prescriptions.

PAP (Patient Assistance Program) requests. Documents actions taken runs weekly reports keeps open lines of communication by facilitating between pharmacy other healthcare professions the patient medication manufacturers and third party payers.

Pharmacy benefit checks at the providers requests; periodically performs software tests for proper functionality to ensure coverage for specific medications.

compliance with all pertinent regulations and laws (HIPAA Board of Pharmacy etc).

duties as assigned.

Education Requirements Associates degree (Bachelors degree preferred)

3 years of retail pharmacy technician experience or related health care administrative and a strong familiarity with the prior authorization process preferred. Working knowledge of third party payer plans and how they are processed of medication reimbursement including the prior authorization process proficiency in the procurement of financial assistance for patients with government-sponsored health plans including Medicare Medicaid and TriCare.

Preferred:

3 years of health care related billing and benefits investigation

1 year of retail pharmacy experience

1 year of PBM payer operations

1 year of hospital/institutional pharmacy

Non-Bargaining Unit 600 - HSO Pharmacy - MSH Mount Sinai Hospital

Required Experience:

IC