Access and Affordability Pharmacy Technician

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Job Summary: Patient Services Specialist I is responsible for conducting benefit verification and completing necessary third party prior authorizations, reimbursement activities, patient assistance and copay program enrollments.  The Patient Services Specialist I also coordinates refill calls, performs documented adherence activities, and coordinates dispensing for specialty medications, high cost prescriptions, and/or infusion medications.  This role requires proactive interaction with physicians, office staff, patients, pharmacies, payers, and patient assistance programs. Occasional travel may be required.

Perform time-sensitive patient services such as patient onboarding, benefit verification, prior authorization, and appeals, as needed, on behalf of patients and their physician to facilitate the process between the doctors’ office and pharmacy to triage and streamline prescription fulfillment. Provide above services for a health system’s ambulatory pharmacy, specialty pharmacy and/or outpatient infusion center environment, as requested.  Verify benefits on both pharmacy and medical coverage, as appropriate. Interact with patients and providers to obtain insurance and patient information needed to request prior authorizations so that medications and other services rendered are reimbursed by payer. Operate with a sense of urgency focused on patient care while communicating with clinic staff, pharmacy/infusion center and patient on the status of the request.     Complete patient adherence activities that may include notification of upcoming refills, coordination, tracking, and confirmation of prescription delivery. Work within health system’s electronic medical record system and other applicable systems to retrieve information needed to deliver services, communicate status and document outcome.  Research various payers to understand their prior authorization and appeals processes. Utilize software to support workflow management and to document activities. Follow defined policies and procedures, meet productivity and quality expectations.  Responsible for facilitating patient enrollment into manufacturer and/or foundation sponsored patient assistance programs. Demonstrate flexibility and adapt to changes in payer, pharmacy and patient assistance program processes and requirements. Establish client relationships with assigned clinic staff, pharmacy and hospital contacts, maintaining professional communications at all times and keeping them informed of patients’ status and payer challenges. Provide integrated services to health system and its component parts to increase prescription capture rate, improve patient outcomes and reduce readmissions. Communicate patient and provider feedback to PHS management to enhance process improvement and continuity of care.  Provides coverage to support clients and patients in the event of onsite resource absences. Performs additional related duties as assigned.

Normally requires a minimum of two (2) years in fields such as Benefit Verification, Prior Authorization, Medical Billing, Medical Office Administration, Social Work, Medical Records, Patient Financial Services, Pharmacy, Nursing or similar vocations. Bachelor's degree program preferred. Previous prior authorization experience preferred. Healthcare certification is preferred but not required:  Certified Pharmacy Technician (CPhT) obtained through PTCB or other medical certification such as Certified Medical Assistant (CMA).  Skills and knowledge: Ability to communicate effectively both orally and in