This position will work under the supervision of the pharmacist and/or technician supervisor. Requires knowledge of drugs, medical nomenclature, and the metric system to enter data into the computer system to fill prescriptions and to obtain reimbursement/payment. Serves as a liaison between the customer and the pharmacists, physicians, and third party administrators. Will also take requests for prescription refills and obtain necessary prior authorizations. Available, as scheduled, to answer inbound calls while protecting the confidentiality of member information and adhering to company policies regarding patient health information (PHI). Makes outbound calls as needed, faxes providers offices, and provides exceptional, courteous and professional customer service. Must demonstrate the ability to research complex issues across multiple databases, work with support resources to resolve member issues, and own problems through to resolution on behalf of the member in real time or follow-up with the member as soon as possible.
Researches clinical data necessary to complete and maintain prior authorization, and interfaces with prescribers to ensure that referrals are complete and include all necessary clinical and demographic information. However, PPAs are prohibited from conducting evaluation or interpretation of clinical data.
Performs test claims to determine copayment/coinsurance amounts, with applicable patient assistance programs. Understand copays, formularies and special pricing to ensure claims are adjudicated correctly and adjustments are performed when applicable.
Builds and maintains strong relationships with patients, and serves a primary point-of-contact throughout the duration of therapy. Educates the patient about coordination of benefits and plan of care.
Obtains applicable financial resources, such as patient assistance and foundation grant support, to assist in covering the patient's portion of therapy. Interfaces with revenue cycle to establish payment plans, when necessary, and coordinates communication with the patient regarding patient financial responsibility.
Documents coordination of benefits and plans of care in pharmacy applications, and communicates to stakeholders as needed to ensure optimal medication therapy. Partner with others to handle and resolve escalated issues when appropriate and act urgently when necessary.
Input orders efficiently with attention to detail, includes order entry, billing, crediting, and updating medical records. Meet departmental standards for production and quality improvement strategies, schedule adherence as well as participate in training and self-development opportunities when appropriate.
Attends to customers and answers telephones in a courteous and timely manner. Serves as a liaison between the customer the pharmacists, physicians, and third party members. May also take requests for prescription refills and obtain necessary prior authorizations.
Works with various parties such as third party payers, providers, and other pharmacies while providing proper documentation for adjudication discrepancies or to obtain prior authorizations when needed.
Skills and knowledge typically attained with acquiring a Pharmacy Technician License. Current and unrestricted licensure is required.
May be required to possess a valid drivers license.
Must demonstrate 3 or more years of experience performing in a pharmacy technician role. Must possess good organizational, problem solving, and computer skills. Must have good written and verbal communication skills for interfacing with all levels of staff, physicians, patients and other contacts.Previous experiences working with pharmacy benefit managers, insurance verification, or patient assistance.
Previous experiences working with pharmacy benefit managers, insurance verification, or patient assistance.
Pharmacy Technician Certification Board (PTCB) certification.Pharmacy technician experience. Knowledge of medication management information system software and automated dispensing systems.Highly proficient in analyzing complex claim transactions and systems with the ability to effectively define issues, collect data, establish facts, and draw valid conclusions.Ability to follow changing instructions and execute special projects as required and additional duties as assigned.
Additional related education and/or experience preferred.
Internal Number: 248716
About Banner Health
You want to change the health care industry – one life at a time. You belong here. You’re excited to be part of the dramatic changes happening in the health care field. In fact, you thrive on change. But you also understand that excellent, compassionate patient care is the true measure of the success of these changes. You belong at Banner Health. Our award-winning, comprehensive health system includes 23 hospitals in seven western states, primary care health centers, research centers, labs, a network of physician practices and much more. Throughout our system, skilled, compassionate professionals use the latest technology to change the way care is provided. If you’re looking to be a key contributor to a forward-looking organization, you’ll experience a wide variety of professional advantages: •Our vision for changing the future of health care gives you the opportunity to leverage your abilities to achieve something historic. •Our expansive system offers you an unmatched variety of clinical settings – from large urban trauma center to small rural hospital, ambulatory to home health. Our system also includes hospitals specializing in cancer, heart health and pediatrics. •Our many loc...ations also translate into a broad selection of exciting and rewarding lifestyle options – from the big city to the wide-open spaces. •Our commitment to healthcare innovation means you always have the latest technologies at your fingertips to help you provide the finest care possible. •The size, success and growth of our system provide you with the stability and options to pursue your desired career path. •Our competitive compensation and comprehensive benefits offer you options to complement your unique needs.