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Summary: Obtain pre-certification and referrals for inpatient and same day encounters. Verification of benefits and pre-certify selected outpatient registrations. Provide specialized support in the areas of insurance and billing information. Support the representatives' solving problems and answering questions. This position will ensure access to integrated health care; achieve clinically appropriate authorization to assure optimal reimbursement for the hospital for services provided. (Ambulatory Pharmacy Administration - Philadelphia, PA)
- Determines patients' insurance requirements for pre-certification, patient payments and coverage limitation and determine necessary action prior to patient discharge.
- Maintain communication with unit based clinical pharmacist, social worker and discharge pharmacy program administrator as needed to obtain complete, accurate financial information required for claim adjudication.
- Any discrepancies to be immediately communicated to unit based clinical pharmacist and discharge concierge program administrator so as to not delay discharge.
- Fax all information required to insurance companies to ascertain an authorization number for pre-certification. Authorization number to be communicated to discharge concierge program staff to allow for prescription to be processed and filled.
- Supports all Concierge Service-related activities from prescription intake to bedside delivery at time of patient discharge when required.
- Assists in establishing policies and procedures specific to the financial aspects of the Concierge Services Program including indigent drug program, Patient Assistance Programs, and pre-certification standard operating procedures.
- Collaborates with internal team members to gather appropriate paperwork, prescription, billing information, &/or prescription
- Provides follow-up for communication to patients and family for pharmaceutical needs and/or additional eligibility information to ensure on-going medication access.
- Interact with medical staff and their designees to obtain complete, accurate, timely clinical and financial information required for payer reimbursement.
- Collaborates with internal team members, insurance companies, drug manufacturers, and prescription benefit administrators to coordinate drug coverage or resolve denials.
- Provides education to Pharmacy, Patient Financial Counselors, and Care Coordination regarding current policy and process as it pertains to the patient assistance program and pharmacy exception process.
- Follow up with all review companies on all pending authorizations and referrals.
Education or Equivalent Experience: High School Diploma is required with 3-5 years of experience in a community-based retail or hospital outpatient pharmacy environment or a financial coordinator in a healthcare setting.
We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives.
Live Your Life's Work
We are an Equal Opportunity and Affirmative Action employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.