ESSENTIAL JOB DUTIES:

• Reviews all high dollar self pay accounts to determine if they would qualify for medication assistance or implant assistance according to departmental policies.
• Works with drug manufacturers to qualify patients for assistance.
• Follows up timely to ensure all accounts that qualify for assistance are completed.
• Maintains ongoing communication with hospital areas regarding assigned accounts, as needed, to facilitate handling of same.
• Keeps logs by facility of accounts approved for assistance.
• Reviews related materials and attends in-services, as directed, to maintain current knowledge of applicable regulations, policies and procedures.
• Ensuring charges are handled appropriately on accounts that are approved for medication assistance or implant assistance.

EDUCATION:

• High school diploma or equivalent 

LICENSURE:

• Certified Pharmacy Technician required

EXPERIENCE:

• Two years of clinical healthcare or pharmacy related experience required.
• Desire extensive knowledge and understanding of opportunities for resources for medication assistance, medication dosages, diagnosis/ICD9 codes, oncology medications, as well as other high cost drugs and implants
• Demonstrates knowledge of hospital billing procedures, payment and reimbursement procedures, pre-certification of medication processes, and insurance verification processes
• Demonstrates very strong analytical and organizational skills to assess and coordinate reimbursement of services, assure appropriate utilization of health care resources, increase team activity to identify and implement utilization refinement, improve patient and physician satisfaction, and the need for collaboration and compliance with hospital expectations.
• Demonstrates an understanding of the role of payers and providers, the need for cost containment and the effect of appropriate resource utilization
• Requires strong knowledge of pharmacy terminology, medical terminology, data systems retrieval, and manipulation necessary to prepare studies and reports
• Demonstrates a positive working relationship, leadership, group cohesion, and presentation skills to communicate with professional medical personnel, hospital staff, patients, pharmaceutical representatives, etc. to gain and maintain compliance, while promoting teamwork and group achievement
• Demonstrates a high level of interpersonal and communication skills, both verbal and written, in order to interact effectively with all internal and external customers (patients and their families) as well as adhere to all HIPAA requirements
• Demonstrates working knowledge of the English language both verbal and written
  Must be able to handle potentially stressful situations and multiple tasks simultaneously, including instructing and counseling patients regarding Lutheran Health Network payment policies and public assistance programs.