Pharmacy Operations Specialist

3 weeks ago

Lexington, United States Common Spirit Full time

Overview

Saint Joseph Hospital is a 433-bed facility located in Lexington Kentucky. Founded in 1877 a small group of Sisters of Charity of Nazareth in Kentucky led by Sister Euphrasia Stafford began their health ministry. Their mission was to provide compassionate care to the poor and underserved - a tradition still carried out today. Saint Joseph Hospital primarily serves central and eastern Kentucky with a full range of services including distinguished awards for cardiology orthopedics and stroke care. CHI Saint Joseph Health supports 5000 active employees 8 hospitals specialty clinics and a Medical Group with more than 200 locations across Central and Eastern KY. CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health in 2019. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community.

Responsibilities

Job Summary / Purpose

The Pharmacy Operations Specialist is responsible for CHI Saint Joseph Health System's Medication Assistance Programs. The Pharmacy Operations Specialist applies knowledge of pharmaceuticals, insurance plans, social security benefits, manufacturers' pharmaceutical assistance programs (PAP), low income subsidies, Medicare/Medicaid, community social services, Cover Rx, and disease-specific grant opportunities to help meet the medication requirements of patients in need. The position coordinates directly with patients, their families, providers, and agencies.

Essential Key Job Responsibilities

* Research program availability and patient requirements to optimize patient access to programs such as Pharmaceutical Assistance programs (PAP), bulk replacement programs, Dispensary of Hope, assistance grants, etc.
* Coordinate patient care by working closely with physicians, case managers, business personnel, nurse practitioners, clinic personnel, etc.
* Develop policies and procedures as applicable to patient assistance.
* Effectively manage a patient tracking database to track patient assistance applications, approvals, receipt of medication, dispensing, billing, and compliance. Manage external agreements, tracking, and billing.
* Oversee the patient assistance process and maintain records of program assistance, compile and submit financial reports to committees, and perform required audits.
* Coordinate implementation of new patient assistance programs, including submission of required applications, development of policies and procedures, and affiliation agreements/contracts.
* Manage and approve CHI Saint Joseph Health Charity Medication Expenses.
* Serve as a consultant to other facilities to implement patient assistance programs.
* Educate case managers, nurses, physicians, medical office staff, and business office staff of available programs, and provide feedback regarding compliance with referrals, formulary, and documentation.
* Participate with Conifer for hospital medication denial recovery.
* Other duties as assigned by management.

The job summary and responsibilities listed above are designed to indicate the general nature of the work performed within this job. They are not designed to contain or be interpreted as a comprehensive inventory of all job responsibilities required of employees assigned to this job. Employees may be required to perform other duties as assigned.

Qualifications

Required Education and Experience

* Pharmacy Technician PTCB certification or Master level degree required

Required Licensure and Certifications

* National Pharmacy Technician Certification

OR

* Certification as an Affordable Care Act (ACA) consultant within first six months of employment

Required Minimum Knowledge, Skills, Abilities and Training

* Knowledge of Medicaid, Medicare Advantage plans, Medicare Part D
* Knowledge of hospital revenue cycle.
* Knowledge of regulatory requirements applicable to the Pharmacy.
* Ability to convey information effectively in face to face, verbal and written communication.
* Computer applications such as Microsoft Office

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