Amber Pharmacy, Exceptions Specialist - Full Time
Company Name:
Hy-Vee Food Stores
Page 1 Job Description Exceptions Specialist Department: Customer Accounts Job Relationships: (cid:1) (cid:1) Reports to: Supervisor, Customer Support & Solutions Team Supervises: N/A Job
Responsibilities: Responsible for prior authorizations, pharmacy rejections. investigation and application process of Patient Assistance Programs and copay cards for patients in need. Communicate and coordinate status of financial assistance and prior authorizations within Customer Accounts, the Pharmacy, and all other team members as needed. General duties include but are not limited to: 1. Provide support for Amber Pharmacy and Hy-Vee Pharmacy Solutions (HPS). 2. Works and communicates with Managers of Customer Accounts, Senior Customer Account Specialists, Benefit Coordinators, Pharmacy staff, and Supervisor of Support and Solutions. 3. Must maintain the established workflow within the Customer Accounts department and adhere to the company/departments Policy and Procedure manual, including the follow-up policy. 4. Researches and applies to Patient Assistance Programs (PAP) for patients in need. 5. Contacts patients and referring clients regarding PAP application and process, and any PA or reject issues as applicable. 6. Distributes and communicates information regarding PAPs, PAs and rejects to appropriate internal departments. 7. Ensures that PAP applications are complete and accurate prior to submission to PAP Foundations, when applicable. 8. Responsible for checking remaining grant amount, grant expiration dates, and renewal of PAPs when applicable, and updating PAP grant tracking spreadsheet from daily report. 9. Responsible for any reports pertaining to PAPs and prior authorizations. 10. Responsible for input of all PAPs and copay cards worked on appropriate spreadsheets. 11. Responsible for reversing and voiding all test claims. 12. Responsible for informing appropriate internal departments of any patient/referring client circumstance that could potentially become a problem situation. 13. Must be knowledgeable about prior authorizations and handle them according to department policy. 14. Responsible for problem solving of rejected claims received from the pharmacy. Exceptions Specialist Page - 1 Amber Enterprises, Inc. dba Amber Pharmacy April 2014 Page 2 15. Responsible for input of all pertinent information regarding PAs and rejections into the system. 16. Responsible for renewal of prior authorizations. 17. Ensures that proper ICD-9/ICD-10 and HCPCS codes are added to correspondences for specialty patients as required by insurance companies. 18. Adheres to all company policies as indicated in the handbook and directives issued by management. Has reviewed Accreditation Policy and Procedure manual. 19. Maintains professionalism at all times and works as a team member with all other employees in a courteous, respectful and cooperative manner. This list is in no way to be used as an all-encompassing list of duties. The intention of the aforementioned job description is to be used as a guide to assist in accomplishing company and department objectives, covering only primary functions and responsibilities. Minimum Qualifications: Education: Education: Education: Education: High school
Experience:
Experience:
Experience:
Experience: (cid:1) Medicare, Medicaid and Commercial Insurance, and renal programs related to pharmacy billing, grants, copay cards, prior authorizations, and rejections. Prior Patient Assistance Program and co-pay card experience Prior PA experience Prior experience troubleshooting rejected pharmacy claims (cid:1) (cid:1) (cid:1) (cid:1) Microsoft Office computer applications (cid:1) Medical Terminology
Qualifications: Excellent customer service skills. (cid:1) Demonstrates ability to take direction, work well with others, and work in a team environment. (cid:1) (cid:1) Must be detail oriented and maintain a high level of accuracy. (cid:1) (cid:1) Effective verbal and written communication skills. Effectively works in a fast paced environment. Physical Requirement: (cid:1) (cid:1) (cid:1) In an 8 hour day the employee may be asked to lift/carry 10 lbs. In an 8 hour day the employee may stand/walk approximately 1 hour. In an 8 hour day the employee sits approximately 7 hours. Approved By: Employee: _________________________________________________________________________ Date __________ Manager:__________________________________________________________________________ Date __________ Exceptions Specialist Page - 2 Amber Enterprises, Inc. dba Amber Pharmacy April 2014Estimated Salary: $20 to $28 per hour based on qualifications.
Hy-Vee Food Stores
Page 1 Job Description Exceptions Specialist Department: Customer Accounts Job Relationships: (cid:1) (cid:1) Reports to: Supervisor, Customer Support & Solutions Team Supervises: N/A Job
Responsibilities: Responsible for prior authorizations, pharmacy rejections. investigation and application process of Patient Assistance Programs and copay cards for patients in need. Communicate and coordinate status of financial assistance and prior authorizations within Customer Accounts, the Pharmacy, and all other team members as needed. General duties include but are not limited to: 1. Provide support for Amber Pharmacy and Hy-Vee Pharmacy Solutions (HPS). 2. Works and communicates with Managers of Customer Accounts, Senior Customer Account Specialists, Benefit Coordinators, Pharmacy staff, and Supervisor of Support and Solutions. 3. Must maintain the established workflow within the Customer Accounts department and adhere to the company/departments Policy and Procedure manual, including the follow-up policy. 4. Researches and applies to Patient Assistance Programs (PAP) for patients in need. 5. Contacts patients and referring clients regarding PAP application and process, and any PA or reject issues as applicable. 6. Distributes and communicates information regarding PAPs, PAs and rejects to appropriate internal departments. 7. Ensures that PAP applications are complete and accurate prior to submission to PAP Foundations, when applicable. 8. Responsible for checking remaining grant amount, grant expiration dates, and renewal of PAPs when applicable, and updating PAP grant tracking spreadsheet from daily report. 9. Responsible for any reports pertaining to PAPs and prior authorizations. 10. Responsible for input of all PAPs and copay cards worked on appropriate spreadsheets. 11. Responsible for reversing and voiding all test claims. 12. Responsible for informing appropriate internal departments of any patient/referring client circumstance that could potentially become a problem situation. 13. Must be knowledgeable about prior authorizations and handle them according to department policy. 14. Responsible for problem solving of rejected claims received from the pharmacy. Exceptions Specialist Page - 1 Amber Enterprises, Inc. dba Amber Pharmacy April 2014 Page 2 15. Responsible for input of all pertinent information regarding PAs and rejections into the system. 16. Responsible for renewal of prior authorizations. 17. Ensures that proper ICD-9/ICD-10 and HCPCS codes are added to correspondences for specialty patients as required by insurance companies. 18. Adheres to all company policies as indicated in the handbook and directives issued by management. Has reviewed Accreditation Policy and Procedure manual. 19. Maintains professionalism at all times and works as a team member with all other employees in a courteous, respectful and cooperative manner. This list is in no way to be used as an all-encompassing list of duties. The intention of the aforementioned job description is to be used as a guide to assist in accomplishing company and department objectives, covering only primary functions and responsibilities. Minimum Qualifications: Education: Education: Education: Education: High school
Experience:
Experience:
Experience:
Experience: (cid:1) Medicare, Medicaid and Commercial Insurance, and renal programs related to pharmacy billing, grants, copay cards, prior authorizations, and rejections. Prior Patient Assistance Program and co-pay card experience Prior PA experience Prior experience troubleshooting rejected pharmacy claims (cid:1) (cid:1) (cid:1) (cid:1) Microsoft Office computer applications (cid:1) Medical Terminology
Qualifications: Excellent customer service skills. (cid:1) Demonstrates ability to take direction, work well with others, and work in a team environment. (cid:1) (cid:1) Must be detail oriented and maintain a high level of accuracy. (cid:1) (cid:1) Effective verbal and written communication skills. Effectively works in a fast paced environment. Physical Requirement: (cid:1) (cid:1) (cid:1) In an 8 hour day the employee may be asked to lift/carry 10 lbs. In an 8 hour day the employee may stand/walk approximately 1 hour. In an 8 hour day the employee sits approximately 7 hours. Approved By: Employee: _________________________________________________________________________ Date __________ Manager:__________________________________________________________________________ Date __________ Exceptions Specialist Page - 2 Amber Enterprises, Inc. dba Amber Pharmacy April 2014Estimated Salary: $20 to $28 per hour based on qualifications.
|
|
 | |
