Pharmacy Support Liaison (Hybrid)

• Access care management documentation systems for data entry and to support the existing programs and processes by collecting information, utilizing appropriate department policies, procedures and guidelines specific to members' eligibility, benefits and contracts.
• Perform intake of service requests from providers or members received electronically, or via telephone or fax.
• Triage and respond to incoming phone calls providing information and assistance to meet the caller's needs.
• Authorize service(s) based on plan design or clinical guidelines in accordance with the department policies/guidelines.
• Improve patient service experience and maximize pharmacy revenue through provision of prior authorization services on behalf of patients needing high cost medications.
• Conduct patient insurance, benefits and financial investigation and verification by directly communicating with patients. Complete initial and renewal prior authorization forms, negotiate authorization status with insurers, track status of medication approval, and when necessary, alert stakeholders of denials or nonresponse.
• Identify patient needs and ensure coverage of medication on their insurance plan through benefits investigation. If not covered, obtain necessary information from medical record, patient, and provider to enable justification for Patient Assistance program or copay assistance. Contact patients to provide information related to these resources.
• Facilitate enrollment of patients in patient assistance programs and collaborate with social services and case management on patient assistance. Assist pharmacists with preparing letters of medical necessity and coordinating peer-to-peer conferences.
• Expedite pharmacy workflow and enhance patient care by preventing therapy interruptions due to insurance issues in conjunction with pharmacists, physicians, transition care coordinators, nursing, and clinic staff. Communicate and collaborate regarding patient therapy interruptions, additional therapy monitoring requirements, and alternative care delivery setting options.
• Participate in revenue cycle committees to help identify causes of denied claims and develop workflow solutions to optimize revenue capture
• Facilitate staff training and competency, education and practice advancement

• Train new staff members
• Maintain a training and competency program for all staff that meets accreditation standards
• Coordinate with Pharmacy leadership to develop training experiences/competencies
• Represent the department at hospital meetings, committees, and events as requested * Patient Engagement Tele pharmacy Support:

• Answer incoming calls and respond to electronic communications
• Assist health care providers and patients by greeting them by phone; answering questions and requests; referring inquiries to the site pharmacist(s) as needed.
• Handle customer inquiries both telephonically and by email
• Research required information using available resources
• Manage and resolve customer complaints

• Performs other duties as assigned.
• Complies with all policies and standards.
• For specific duties and responsibilities, refer to documentation provided by the department during orientation.
• Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients. Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace.

• High School Equivalent / GED (Required)
• Bachelor's Degree in health care related or business field (Preferred)

• 3+ years Strong clinical background experience in a medical office or other health care setting (Required)

• Knowledge of medical terminology and ICD9, ICD10, CPT, and DRG codes (Required proficiency)
• Knowledge of third-party insurance billing practices, federal and state regulations with regard to billing and reimbursement, internal billing structure, and billing procedures (Required proficiency)
• Experience with patient assistance programs (Required proficiency)

• Certified Pharmacy Technician (CPhT) (Required Upon Hire)

• Standing Occasionally
• Walking Occasionally
• Sitting Constantly
• Lifting Rarely up to 20 lbs
• Carrying Rarely up to 20 lbs
• Pushing Rarely up to 20 lbs
• Pulling Rarely up to 20 lbs
• Climbing Rarely up to 20 lbs
• Balancing Rarely
• Stooping Rarely
• Kneeling Rarely
• Crouching Rarely
• Crawling Rarely
• Reaching Rarely
• Handling Occasionally
• Grasping Occasionally
• Feeling Rarely
• Talking Constantly
• Hearing Constantly
• Repetitive Motions Frequently
• Eye/Hand/Foot Coordination Frequently

• 10%

Lake Health