St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care.
Responsible for obtaining prior authorization, facilitating patient access to medication, coordinating patient care to include documentation, dispensing and distribution under the supervision of licensed pharmacist meeting regulatory and accrediting agency requirements. Responsible for medication authorizations to optimize patient access to their medication therapy. Answers phone calls and emails. Completes verification and identification of covered and non-covered medications, explanations of benefits. Provides follow-up to families, providers, and payors regarding referral issues, insurance eligibility and authorization, applicable copay assistance, and initial and ongoing delivery of Specialty medications.
JOB DUTIES AND RESPONSIBILITIES:
- Demonstrates knowledge and practice of Specialty Pharmacy accreditation guidelines, FDA regulations and guidelines, HIPAA regulations and confidentiality. Maintains current records to assure compliance with regulatory, accreditation and payor reporting requirements. Acquires necessary signatures for regulatory forms and develops and maintains tracking tools.
- Provides exceptional customer service when answering incoming patient calls, communicating with patients on urgent requests, and communicating with medical/office staff to obtain key information needed.
- Coordinates the receipt of incoming calls from patients as well as outgoing calls in a timely and expeditions fashion, in attempt to maximize cash flow while representing SLUHN in a positive fashion.
- Maintains current information regarding manufacturers assistance programs specific for complex and high-cost Specialty medications to assure optimal cost-effective care.
- Assists in meeting initial and ongoing requirements required to obtain limited distribution drugs.
- Maintains contact with manufacturer sales representatives to improve medication access.
- Handles complex issues related to the coordination and ongoing provision of Specialty medications.
- Assists in securing new payor contracts necessary to grow business.
- Performs intake process for referrals via electronic transmission, email, fax/paper format and communication with physician offices. Coordinates with physician office for any information, documentation, questions, inquiries. etc. Obtains required information, including diagnosis, previous treatment, lab results as needed. Provide pertinent details as required.
- Verifies eligibility and insurance benefits for each patient referral. Communicates expected out-of-pocket costs and copay assistance programs and outstanding financial obligations as appropriate.
- Obtains preauthorization for Specialty medications per insurance guidelines. Provides detailed follow-up as required to assure timely receipt and maintain or exceed industry standards for start of care.
- Forwards referral to alternate service providers as required when unable to provide services.
- Creates and/or updates patient record. Ensures required documentation is accurately inputted into software system, including but not limited to visit notes, referral/authorization numbers, eligibility review, proper payor plan entries for research and standard-of-care follow up.
- Contacts family and/or responsible party, as necessary, to inform them of any insurance issues or restrictions, ensuring that insurance information is clearly relayed to and understood by family and/or responsible party. Contact physician office with all information that requires follow-up.
- Serves as patient/caregiver initial introduction to Homestar Specialty Pharmacy services including updating medication profile, refill coordination, access to emergency/after-hours services, and pharmacist escalation, as appropriate.
- Assists the pharmacist in initial development and ongoing completion of the Specialty medication patient care plan. Documents in patient profile and “hands off” to pharmacist as required.
- Provides follow up to assist the pharmacist in monitoring compliance and medication adherence, response to therapy, side effects and adverse reactions. Communicates with physician office.
- Coordinates and schedules the Specialty medication delivery process. Assist in delivery preparation, print delivery receipts for attachment to drugs/supplies being delivered.
- Collects or facilitates payment of outstanding balances. Assist in posting of payments or cash transaction.
- Demonstrates financial responsibility and accountability through effective and efficient use of resources in daily procedures, processes, and practices.
- Complies with Network and departmental policies regarding issues of employee, patient and environmental safety and follows appropriate reporting requirements.
- Demonstrates Performance Improvement in the following areas as appropriate: Clinical Care/Outcomes, Customer/Service Improvement, Operational System/Process, and Safety.
- Completes any special projects designated by the Manager in a timely and effective manner. Other
duties as assigned by management.
PHYSICAL AND SENSORY REQUIREMENTS:
Medium Work
Exertional activity
Occasionally lift and/or carry 50 lbs. Frequently lift and/or carry 25 lbs. Being able to frequently lift or carry objects weighing up to 25 pounds is often more critical that being able to lift up to 50 lbs at a time. Stand and/or walk at least 6 hours in an 8-hour work day. Very few medium occupations in the national economy are performed primarily in a sitting position.
Nonexertional activity
Stooping (bending at the waist) and crouching"(stooping and bending at the knee) -required frequently in most medium jobs. Handling (grasping) - required frequently in most medium jobs. Fingering (fine manipulation) - required only occasionally in most medium jobs. Important: The functional capacity to perform medium work includes the functional capacity to perform sedentary and light work. Good physical and mental health. Neat, clean, free from body odors, and conforms to the uniform code.
Physical Demands (continued):
Constant standing and walking during work periods. Turning, stooping, bending, climbing, stretching and lifting in the provision of comprehensive business management. Finger and hand dexterity necessary to handle office equipment. Visual and auditory acuity required to provide comprehensive job functions.
Environmental Conditions:
Inside - Office environment. Outside - Traveling to office errands in extreme cold or heat, wet and/or humid. Snow, ice and/or fog. Hazards - Exposure to contagious disease. Road and driving.
EDUCATION:
High School degree with prior related work experience
TRAINING AND EXPERIENCE:
Specialty Pharmacy experience required. Certified Pharmacy technician preferred.
Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's!!