Pharmacy Support Analyst

SUMMARY: We are currently seeking a Pharmacy Support Analyst to join our Hospital Admin Pharmacy team. This position is part-time with benefits, 40 hours per pay period, day shift, Monday – Friday, 8 hr shifts. Work Location: Positive Care Clinic Purpose of this position: Under the direct supervision, is responsible for providing coordination, clarification, and communication of all financial aspects of pharmacy, including insurance and authorization verification, claims research, patient assistance, and formulary management. This role will also be used in a patient facing capacity to evaluate, assist, and support patients who are un-insured or under insured in navigating billing aspects associated with their care in Positive Care Clinic.In addition, the individual will support the Pharmacy department by leading projects and developing processes needed for day-to-day business activities RESPONSIBILITIES: - Verifies insurance coverage and obtains authorizations and certifications for the patient’s medication treatment. Obtains all necessary signatures and documentation required by the patient’s third party payer. Accurately and completely documents all information into EPIC to ensure maximum reimbursement. Monitors and updates information regarding insurance data, authorizations, and preferred providers. Partners with the clinical care team and insurance provider to ensure continued coverage of patient’s care and maximum reimbursement and minimized financial impact to the patient - Provides financial advocacy, assistance, and support to patients and families, as needed. Assists patients who are un-insured or under insured to access other funding resources and completes required documents. Maintains current working knowledge of Medicare, Medicaid, and other program benefits and criteria, particularly as they pertain to pharmacy benefits. Serves as a liaison between the facility and community/manufacturers in making patient assistance resources available to the patient and family - Acts as a liaison between patient/hospital/provider/payer to enhance account receivables performance, resolves outstanding issues and/or patient concerns, and maximizes service excellence. Monitors pharmacy claim data and EPIC work queues to identify critical reimbursement issues and works with Finance and Billing to resolve them in an expedient and proactive manner. Understands charge master set up and maintenance requirements - Works with Pharmacy leadership on internal audits and external audits from 3rd party payors and government agencies, including but not limited to Medicaid and Medicare - Obtains knowledge of payer requirements and policy benefit structure, including Medicare and Medicaid. Keeps current on payer trends and changes utilizing websites, emails, and bulletin communications. Continually reviews and monitors billing and coding changes affecting Pharmacy - May work directly with providers to obtain prior authorizations for medications - Provides leadership and training to other members of the team and serves as a resource for internal and external customers - Other duties as assigned

Qualifications:

QUALIFICATIONS: Minimum Qualifications: - Associate’s Degree, with a focus on healthcare or finance - 3 year’s professional experience working in pharmacy business office, payer business office, or equivalent area -OR- - An approved equivalent combination of education and experience Preferred Qualifications: - Bachelor’s degree in Business Administration, Health Care Administration, Nursing, Health Information Management, or related healthcare concentration area Knowledge/ Skills/ Abilities: - Requires extensive knowledge of government and commercial payer requirements to ensure accurate and compliant charging and billing of medications - Demonstrated expertise in logical thinking, data preparation, and analysis - Comprehensive knowledge of Microsoft Office (Outlook, Word, Excel and Access) - Strong communication skills, both verbal and written - Knowledge of medical and pharmacy terminology - Ability to communicate effectively with medical providers