<p>Job Description</p> <p>Job Title: Billing Investigation/Prior Authorization Technician - Specialty Pharmacy</p> <p>Department: Pharmacy</p> <p>Reports To: Outpatient/Specialty Pharmacy Manager</p> <p>Job Summary: This position will support the management of patients requiring Specialty Pharmacy Medications. Providing prior authorization services, including insurance benefit investigation, copay assistance, foundation support, and insourcing the dispensing function of Specialty Medications. This position will require ordering the Specialty medications and deliver to individuals as required.</p> <p>Job Responsibilities include:</p> <p>Pharmacy</p> <ul> <li>Assists the pharmacist in all operational activities of the specialty pharmacy in order to optimize customer satisfaction and maximize profitability of the pharmacy. </li><li>Review and screen new patients at intake to determine if patient has adequate prescription coverage. Refer appropriate patients to financial counseling for coverage or charity application. </li><li>Provide customer service through the Specialty Pharmacy Call Center. Triage patient calls to appropriate party. </li><li>Function as primary third party billing resource for Outpatient pharmacy staff. </li><li>Troubleshoot and resolve billing rejections and subsequently rebill claims to appropriate carrier for all commercial, federal, and state insurance plans. </li><li>Submit prior authorization requests, follow up on submitted prior authorization requests and submit claims with approvals as appropriate. </li><li>Identify patients who may qualify for patient medication assistance programs or copay assistance. </li><li>Contact payers for lost medication overrides, replacement, and vacation override approvals. </li><li>Assist with prescription audits. </li><li>Establish and maintain good working relationships with billing operations specialists and Outpatient Clinic pharmacy staff to maintain effective communication regarding third-party billing issues. </li><li>Assist in the development, implementation, and evaluation of third-party billing policies and procedures. Educate pharmacy staff about third-party billing policies and procedures as needed. </li><li>Provide monthly adherence phone calls to patients, when appropriate </li><li>Is flexible assuming the tasks as assigned. </li></ul> <p>Requirements:</p> <p>Education - High school education or GED certificate.</p> <p>Licensure - Pharmacy Technician Certification Board (PTCB) credential</p> <p>Experience - 3-5 years of retail pharmacy technician experience. Prior benefits investigation/prior authorization experience with Specialty pharmacy is preferred.</p> <p>Special skills - Must possess strong verbal and written communication skills and demonstrates exceptional time management skills. Must also have strong customer service and independent problem solving skills.</p> <p>Accountability - This individual reports to Manager, Retail and Specialty Pharmacy Services and is held accountable to maintaining the highest of professional standards and supporting the vision, mission, and goals of the organization. Must complete all hospital and department competencies as required for employment.</p> <p>Physical Requirements - Repetitive use of hands and fingers (e.g., use of computer keyboard); must be able to physically to operate the equipment used for the job.</p> <ul> <li>= Essential functions </li></ul>