Pharmacy Care Coordinator

Job Title: Care Coordinator - Specialty Pharmacy

Department: Pharmacy

Reports To: Outpatient/Specialty Pharmacy Manager

Job Summary: This position will facilitate medication access to patients enrolled in the Specialty Pharmacy Programs by obtaining prior authorization, performing insurance benefit investigation, identifying copay and financial assistance, coordinating medication delivery, and participating in quality improvement initiatives of the pharmacy. This position will answer calls pertaining to the verification of covered and non-covered medications, explaining benefits as well as providing follow-up with patients, providers and payors with issues surrounding authorization, insurance eligibility, copay and financial assistance and also medication delivery.

Job Responsibilities include:

Pharmacy

• Provides information of the pharmacy benefit structure to patients, caregivers, and provider team to facilitate access to medications.
• Performs eligibility verification and submits prior authorization requests and follow-up on submitted prior authorization requests.
• Follows-up with insurance companies and families or patients as necessary to inform them of any insurance problems or restrictions, ensuring that insurance information is understood by the responsible party. Contact clinical office with all information that requires follow-up
• Identify patients who may qualify for patient medication assistance programs or copay assistance. Refer appropriate patients to financial counseling for coverage or charity application when out-of-pocket cost needs support. Informs patient of outstanding financial obligations if needed.
• Contacts payers for lost medication overrides, replacement, and vacation override approvals.
• Provides customer service when answering incoming patient calls, communicating with patients on urgent requests, and communicating with provider staff with key information is needed.
• Establishes and maintains good working relationships with Outpatient pharmacy staff to support effective communication and patient care
• Participates in departmental quality improvement initiatives as required by accreditation.
• Engages monthly adherence phone calls to patients and patient outreach as required by accreditation when appropriate.
• Troubleshoots and resolves billing rejections and subsequently rebill claims to appropriate carrier for all commercial, federal, and state insurance plans. Function as primary third party billing resource for Outpatient pharmacy staff.
• Is flexible assuming other duties as assigned by the Outpatient Pharmacy Manager.

Requirements:

Education - High school education or GED certificate required. Bachelor's degree preferred.

Experience - 3-5 years of relative job experience is required. Prior benefits investigation/prior authorization and care coordination experience with specialty medication is preferred.

Work setting - Mainly remote with scheduled in-person days when needed.

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. Strong computer and organizational skills.

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.

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.

• = Essential functions

Current Openings for Pharmacy Care Coordinator Jobs at Cayuga Health System