Pharmacy Care Coordinator

JOB SUMMARY: The patient care coordinator works with patients via in-person and telephone to compassionately and efficiently coordinate their medication orders.

The patient care coordinator needs to be able to communicate well with patients regarding the price of their co-payments and financial assistance programs when needed.

They also must provide compassionate, superior customer service, promptly understanding the importance of adherence to specialty medications.

They also fill the prescriptions, adjudicate the claims, and balance this cash register.

Effectively manages and facilitates the timely resolution of insurance denials and or authorizations.

Tracks and reconciles incoming drug shipments and ensures account balances are adjusted accordingly.

JOB SPECIFIC DUTIES AND RESPONSIBILITIES: 1.

Analyzes patient data to identify potential candidates for enrollment into a pharmacy patient assistance program.

2.

Obtains and verifies patient prescription insurance information.

3.

Obtains and verifies information regarding patient enrollment or attempting enrollment in vendor-sponsored drug replacement programs.

4.

Pre-screens patients by evaluating and completing documentation for assistance programs on behalf of the patient.

Obtains patient signature when required.

5.

Submits required enrollment documentation for assistance review.

6.

Maintains accurate patient records for programs 7.

Oversees, execution of replacement drug orders and tracks shipments.

8.

Monitors pharmacy dispensing records and discerns qualified patients based on individual criteria.

9.

Review the prescription to obtain the correct dosing information.

10.

Verifies that third-party eligibility tools are provided 11.

Initiates drug replacement or assistance orders accurately and in timely manner following the criteria set forth by the assistance programs.

12.

Monitors submitted drug orders and verifies shipment is received by CARTI promptly.

13.

Reconcile replacement drug shipments received to orders placed.

14.

Obtains prior authorization from PBM for patients prescribed medications.

15.

Ability to read and understand medical records to determine if drugs are being used for an FDA-approved indication.

16.

Communicates effectively over the telephone to set up shipment or pick-up of the patients medication.

17.

Utilizes shipping tools and packing materials to ensure drugs are packaged safely.

18.

Verifies invoices of received drugs.

19.

Maintains drug replacement inventory.

20.

Maintains drug inventory ordered by CARTI.

21.

Maintains and updates records.

22.

Facilitates resolution of outstanding replacement or reimbursement issues.

23.

Understands prescription billing and accounts receivable issues.

24.

Analyzes pharmacy billing system to ensure that charges and reimbursements appear accurate.

Demonstrates thorough understanding of pharmacy account denials by analyzing payments, adjustments, or denials to ensure transactions are posted before the request for replacement or assis...