PHARMACY BENEFITS COORDINATOR

3 months ago

Pittsburgh, United States StateServ Full time
Essential Functions

Note: The essential duties and primary accountabilities below are intended to describe the general content and requirements of this position and are not intended to be an exhaustive statement of duties. Incumbents may perform all or most of the primary accountabilities listed below. Specific tasks, responsibilities or competencies may be documented in the incumbent's performance objectives as outlined by the incumbent's immediate supervisor or manager.

1. Processes consults via information provided and accurately completing the data entry in the billing proprietary software.
2. Navigates between various software systems for communication and completion of assignments.
3. Communicates both directly and indirectly within the organization and with hospice partners via chat, email, phone calls, and patient profile documentation.
4. Assists with verification that pharmacy claims for appropriate processing. Provides appropriate and accurate information to local pharmacies in accordance with approved insurance information as determined by Delta Care and hospice partner (i.e., Name, DOB, ID, BIN, Group, medication benefits, etc.).
5. Answers the phone, responds to routine questions and outreaches to a pharmacist as needed.
6. Accurately includes necessary information when assisting clinicians for the procurement of hospice patient medication requirements.
7. Assists with acquiring and completing the Prior Authorization process with hospice partners to provide adequate insurance coverage at local pharmacies.
8. Completes non-queue work related tasks such as hospice census, preparation of go live information, processing spreadsheets, retroactive adjudication, and FedEx delivery.
9. Outreaches to pharmacy partners to complete stock checks and/or medication procurement, to ensure medications are available for patient care. Assists with dispatching medications for hospice partners.
10. Completes assigned responsibilities with a high level of efficiency and accuracy. Works cooperatively with fellow Pharmacy Benefit Coordinator (PBC) team members and others on various teams throughout the organization. Maintains a high level of productivity while balancing quality of care.
11. Assists in training new team members as assigned.

Marginal or Additional Functions

1. Adheres to all HIPAA protocols for patient privacy.
2. Performs other duties as assigned or apparent to support the achievement of Delta Care Rx's goals and objectives.

Supervisory and Managerial Responsibility

•This position does not have any supervisory responsibilities.

Knowledge, Skills & Abilities

Education, Licensure or Certification:
•High School Diploma required
•Associate's Degree preferred

Work Experience or Related Experience:
•Prior experience in insurance benefits preferred
•Prior experience with telecommunications preferred
•Experience with various web browsers (Google Chrome / Firefox), Google docs, Google Sheets or similar software required
•Demonstrated ability to effectively communicate required
•Proven ability to manage multiple projects simultaneously while paying strict attention to detail required

Specialized Knowledge, Skills & Abilities:
•Excellent listening skills
•Excellent verbal and written communication skills
•Excellent computer skills
•A high level or professionalism, customer service and discretion is required to represent the organization and interact with other organizations as described
•Ability to maintain confidentiality, and to exercise discretion and good judgment

Equipment:
•Working knowledge of a PC, business and communications software (MS Office) and web-based tools are required

Travel Requirements and Conditions

•No travel required

Work Environment, Conditions and Demands

•Work is performed in both a home and office environment

Physical Requirements and Demands

Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described.
•This position entails a high level of work performed at a computer terminal with two additional monitors and telephone or headset equipment throughout the day
•Regular eye-hand coordination and manual dexterity is required to operate office equipment

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