When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.
This position acts as a liaison between the specialty/retail pharmacy and the prescribers to document, submit, communicate outcomes and appeal, if necessary, all pharmacy/medical prior authorizations. Is also involved in all aspects of obtaining patient access to prescribed medication.
Job Description:
Essential Responsibilities:
1. Understands product and payer reimbursement landscape and prior authorization guidelines and processes.
2. Collects and reviews all data needed pharmacy and/or medical for prior authorization approvals.
3. Resolves insurance related issues, including prior authorizations (PAs), and assist patients with various forms of financial assistance.
4. Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly, maintains frequent phone contact with patient, provider and pharmacy staff; and clarifies prescription orders with pharmacist and/or clinician as appropriate.
5. Serves as the direct patient and provider contact for pharmacy benefit information, clinical and program information.
Required Qualifications:
1. High School diploma or GED required..
3. 3-5 years related work experience required in Pharmacy.
4. Experience with computer systems required, including web based applications and some Microsoft Office applications which may include Outlook, Word, Excel, PowerPoint or Access.
Preferred Qualifications:
1. PTCB certification
2. License Mass Registered Pharmacy Tech.
3. Specialty Pharmacy experience and/or prior authorization experience.
4. Knowledge of medication use in RA, GI, transplant, hepatitis C, infectious disease (including HIV), and/or oncology a plus.
Competencies:
1. Decision Making: Ability to make decisions that are guided by general instructions and practices requiring some interpretation. May make recommendations for solving problems of moderate complexity and importance.
2. Problem Solving: Ability to address problems that are varied, requiring analysis or interpretation of the situation using direct observation, knowledge and skills based on general precedents.
3. Independence of Action: Ability to follow precedents and procedures. May set priorities and organize work within general guidelines. Seeks assistance when confronted with difficult and/or unpredictable situations. Work progress is monitored by supervisor/manager.
4. Written Communications: Ability to communicate clearly and effectively in written English with internal and external customers.
5. Oral Communications: Ability to comprehend and communicate complex verbal information in English to medical center staff, patients, families and external customers.
6. Knowledge: Ability to demonstrate full working knowledge of standard concepts, practices, procedures and policies with the ability to use them in varied situations.
7. Teamwork: Ability to act as a team leader for small projects or work groups, creating a collaborative and respectful team environment and improving workflows. Results may impact the operations of one or more departments.
8. Customer Service: Ability to provide a high level of customer service to patients, visitors, staff and external customers in a professional, service-oriented, respectful manner using skills in active listening and problem solving. Ability to remain calm in stressful situations.
Pay Range:
$27.00 – $36.34
The pay range listed for this position is the base hourly wage range the organization reasonably and in good faith expects to pay for this position at this time. Actual compensation is determined based on several factors, that may include seniority, education, training, relevant experience, relevant certifications, geography of work location, job responsibilities, or other applicable factors permissible by law. Compensation may exceed the base hourly rate depending on shift differentials, call pay, premium pay, overtime pay, and other additional pay practices, as applicable to the position and in accordance with the law.
