Newport News, Virginia Hiring Range $23.90 - $31.10/Hourly Actual pay is determined based on job-related factors such as relevant experience, education, credentials, skills, internal equity, and business needs. Overview Supports patient access to specialty medications by coordinating prior authorizations, benefit investigations, and patient assistance programs under the supervision of a licensed pharmacist, while serving as a liaison between patients, providers, payers, and manufacturers to facilitate timely medication approval and therapy initiation. Ensures accurate documentation, clear communication, and compliance with specialty pharmacy accreditation standards and all applicable state and federal regulations while supporting a positive patient experience. What you will do Timely process of referrals and submit clinical supporting documentation to insurance carriers, manufacturers, or foundations to expedite prior authorization and/or patient assistance processes. Collaborate with other departments to assist in obtaining prior authorizations, patient assistance medications or financial assistance. Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed. Follows prior authorization and/or patient assistance workflows and policies/procedures. Demonstrates the ability to work independently, meet deadlines and possesses excellent time management skills. Perform tasks accurately and efficiently. Possesses excellent interpersonal, customer service and communication skills (both written and verbal); timely responses to key stakeholders. Accurate documentation of all intake referrals and/or prior authorization information in patient medical record or patient assistance tracking software in compliance with policy and procedure/workflow. Completes timely documentation within the required tracking systems and retrieves necessary documentation and maintains up to date knowledge of the pharmaceutical companies’ patient assistance programs. Proactively tracks and manages patient refills/outreach to ensure timely prescription/infusion service. Proactively works on prior authorization and patient assistance enrollments that are due to expire. Secure patients’ demographic and medical information in compliance with organization HIPAA policies and procedures. Assists management with inspections, audits, reports and training to ensure compliance with standards and to provide quality service.
Qualifications
Education
Program Graduate, Pharmacy Technician Training Program or equivalent (Preferred) or Program Graduate, Licensed Practical Nurse (Required) or Program Graduate, Certified Medical Assistant (Required)
Experience
3-4 years
Experience
as a Pharmacy Technician, LPN or CMA (in lieu of education) (Required) 1 year
Experience
obtaining and managing medication prior authorization as part of job function (Preferred) 1 year Prior
Experience
obtaining and managing patient assistance program applications (Preferred)
Skills and Abilities
Familiar with medical and pharmacy terminology Prescription drug and over-the-counter knowledge Basic math skills, including pharmaceutical calculations Basic pharmacy workflow Understanding pharmacy computer systems Ability to navigate and read electronic health record Strong written and verbal communication skills Ability to prioritize, problem solve and multitask Excellent customer service skills Knowledge of patient assistance programs
Experience
with prior authorization of medications Strong organizational skills and detail oriented Licenses and Certifications Registered Pharmacy Technician - Virginia Department of Health Professions (VDHP) Upon Hire(Required) and Pharmacy Technician Certification Board (PTCB) - Pharmacy Technician Certification Board (PTCB) PTCB or ExCPT Upon Hire(Required) or Licensed Practical Nurse (LPN) - Virginia Department of Health Professions (VDHP) Upon Hire(Required) or Certified Medical Assistant (CMA) - American Association of Medical Assistants (AAMA) Upon Hire(Required) Advanced certification in specialty pharmacy field (PTCB, ASHP, NCODA and other approved programs) (Preferred) To learn more about being a team member with Riverside Health System visit us at https://www.riversideonline.com/careers. If loving your work is important to you, consider a career at Riverside. By joining our team, you can make a difference in people's lives. Our mission is to care for others as we would care for those we love. We extend that sense of caring to every patient, resident and customer, as well as to each member of our team. We offer care at all stages of life, in hundreds of locations, giving you room to grow your career, along with great benefits and perks. At Riverside Health, your trust and safety are our top priorities. Unfortunately, job scams are on the rise across the country, and we want to help you feel confident in knowing what is — and is not — part of our hiring process. Learn more about how to recognize a legitimate Riverside job opportunity and what to do if you suspect a scam by visiting this site.