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Glen Burnie, Maryland
Posted: 03-Jan-25
Location: Santa Monica, California
Categories:
Internal Number: 145503945
In this role, you will work to improve patient access to treatment and adherence to medically necessary pharmaceuticals by managing patient’s insurance benefits and utilizing established patient assistance programs. You will be expected to use in-depth knowledge of Hematology/Oncology standard of care and research authorizations clearance to train all community practice authorization coordinators. You will work closely with the Manager and Supervisor to ensure appropriate initial training is provided to all new hires as well as provide ongoing training to existing staff members. Incumbent will serve as a resource for all authorization coordinators and community practice managers. Serve as liaison between medical staff, insurance providers and patients to facilitate/coordinate authorization for all medications related to patient care. Responsible for the review, evaluation, and documentation in obtaining authorization for all medications (chemotherapy, infusions, and injections). Major duties include: train new and existing authorizations coordinators in all Hematology/Oncology community practices. verifying insurance benefits for requested medications, confirmation and obtaining appropriate authorizations, act as a liaison for all patients requiring medications in accordance with laws and regulations set forth by regulatory entities. Work closely with Hem/Onc Financial Counselors, Hem/Onc Patient Assistance/Co-Pay team and community clinic managers.
Salary range: $28.88/hr - $38.13/hr
Required:
- Pharmacy Technician License in the State of California in good standing.
- Ability to interpret medical information required to perform prior authorizations.
- Ability to interpret medication information required to perform patient assistance.
- Ability to interpret medical information required to perform second level appeals.
- Ability to retrieve, interpret, and utilize departmental and third-party insurance policies and procedures effectively.
- Ability to speak with persons from various social, cultural, economic and educations backgrounds to obtain information and explain authorization process.
- Skill in speaking clearly and distinctly using correct English to communication with telephone callers to obtain information, provide information and explain authorizations process.
- Working knowledge of the UCLA billing codes, their restrictions and applications to individual patient and clinic orders.
- Advanced technical computer skills as required for technical support specific to functional area. Computer skill including proficiency in CareConnect, Microsoft Office Applications, which may include Outlook, Excel, Word and PowerPoint.
- Knowledge of pharmaceutical generic and trade names and their dosage forms, and the ability to cross-reference the most common drugs from memory.
- Knowledge of medical terminology and pharmaceutical abbreviations.
- Knowledge of decimal, fractions, percentages, and metric and apothecary system units to be able to read treatment plans and convert units when necessary.
- Accurately perform mathematical pharmaceutical calculations.
- Ability to accurately select correct product needed to complete an order including product, strength, quantity, and manufacturer.
- Ability to work independently, follow-through on assignments with minimal supervision, and investigate medication information via resources such as Lexicomp, Micromedex, and Up-To-Date.
- Telephone and verbal skills required to communicate clearly and effectively with pharmacists, nurses, physicians and other allied health professionals.
- Conduct critical evaluation of procedures to ensure quality and effect positive change.
- Train, mentor, and serve as a resource to other staff.
- Able to maintain equanimity and composure in the face of resistance and frustration in stressful situations.
- Skill in performing under the stress of frequent interruptions and/or distractions.
- Ability to perform effectively under conditions of fluctuating workload.
- Excellent written and oral communication skills.
- Ability to work independently.
- Able to demonstrate professional, ethical, constructive, positive conduct.
- 3-5 years related work experience required.
- 2 years of oncology related experience
Preferred:
- Bachelor’s degree
