Summary

SUMMARY: Assists with the coordination and implementation of a variety of key specialty pharmacy operational activities related to billing, delivery, tracking, coordination and patient interactions.

DUTIES & ESSENTIAL JOB FUNCTIONS: NOTE: The following are the duties performed by employees in this classification, however, employees may perform other related duties at an equivalent level. Not all duties listed are necessarily performed by each individual in the classification.

1. Acts as the point person for communicating the delivery needs of patients to delivery vendor including any special instructions and feedback, as well as provides tracking information and reviewing all deliver-associated charges.

2. Assists with administrative and operational duties as required.

3. Builds patient-centered relationships including contacting members as needed to coordinate specialty prescription orders; processes new and refill orders.

4. Enrolls and tracks the status of new patient referrals and with initiation of therapy. -

5. Ensures pharmacy claims are being submitted accurately and correctly; reviews billing for specialty and high-cost medications to confirm appropriate reimbursement.

6. Maintains accountability for day-to-day patient reimbursement activities, workload and overall workflow; provides monthly reports of patient and prescription activity to pharmacy & program management.

7. Monitors, follows up with and records all insurance re-authorizations required by payers to help ensure compliance and continuity of treatment; helps to support the appeal process to overturn insurance denials and/or benefit exclusions when needed.

8. Provides specialty medication inventory management including maintaining the day to day medication quantities and oversight of partial prescriptions that were dispensed. Verifies all pertinent medication information, including eligibility, medication prior authorizations, start date of medication, shipping address, and payment information.

9. Works on patient's behalf to identify and assess reimbursement coverage options for those with insurance and to coordinate and/or investigate financial options for those without insurance.

10. Works with prescribers, Clinical Pharmacist Specialists and pharmacists to facilitate the process of obtaining prior authorization from third party payers in order to maximize patients' access to treatment and to coordinate/investigate financial options for those without insurance.

11. Responsible for monthly data management and analysis, specific to Adult Immunology pharmacy patients, pharmaceutical costs and reimbursements.

12. Coordinate courier deliveries for Adult Immunology and Outpatient Pharmacy patients.

13. Processing "return to stock" medication tasks when necessary.

14. Coordinate projects as they arise.

15. Perform other duties as assigned.

Job Roles Specific to Adult Immunology Clinic Position: 1. Responsible for managing special project implementation for example coordinating Automatic Refill Program workflow and compliance. 2. Assist in the clinic with day-to-day operations including, but not limited to, physical presence in clinic or specialty office, coordinating phone calls and clinic appointments, managing Highland and non-Highland Pharmacy patients.
3. Ongoing communication and clinical pharmacist team and Highland Pharmacy. 4. Preparing, processing, renewing and ongoing tracking of Prior Authorization Applications and Patient Assistance Program Applications for Highland Pharmacy and non-Highland Pharmacy Patients. 5. Maintaining clinically and operationally appropriate documentation within Epic Hyperspace and patient chart. 6. Triaging Adult Immunology clinic phone calls and responding to messages.

PAY RANGE: $40.02 - $53.63/hr
The pay range for this position reflects the base pay scale for the role at Alameda Health System. Final compensation will be determined based on several factors, including but not limited to a candidate's experience, education, skills, licenses and certifications, departmental equity, applicable collective bargaining agreements, and the operational needs of the organization. Alameda Health System also offers eligible positions a generous comprehensive benefits program.

MINIMUM QUALIFICATIONS:

Required Licenses/Certifications : Registered Pharmacy Technician with the California State Board of Pharmacy.

Preferred Education : Bachelor's Degree.

Required Education : Associate's degree.

Preferred Qualification/Certificate : Bilingual in Spanish

Preferred Experience : One year of recent experience supporting or directly coordinating specialty pharmacy services in an administrative and/or operation role.