Specialty Pharmacy Financial Access Coordinator, Lead-Psychiatry

The World Trade Center Mental Health (MH) Pharmacy Benefits Coordinator plays a crucial role in coordinating pharmacy benefits for WTC members who receive care at the WTC MH Program. MH Pharmacy Benefits Coordinator interacts with the WTCHP Pharmacy team, patients, hospital employees, specialty pharmacy staff, medical/clinical staff, department managers, and clinics. External contacts include insurance companies on behalf of patient's medical and pharmacy benefits, pharmacies, and providers. These activities include supporting and interacting with patients, coordinating their prescriptions, and working with clinical staff to complete prior authorization requests (when applicable). The World Trade Center Mental Health (MH) Pharmacy Benefits Coordinator reports to WTC MH Program Manager. 

• Works closely with the WTCHP Pharmacy team to ensure patients achieve access to medications
• Assists in the operational workflows including product overrides, prior authorizations, patient navigation, and scheduling as required for referred patients 
• Aids in quality assurance process on WTCHP pharmacy claims
• Assists in answering pharmacy benefit questions.
• Provides a high level of customer service by triaging medication access questions including medication rejections at point of sale 
• Escalates patient and provider concerns in a timely manner 
• Schedules appointments, monitors follow-ups and addresses no-shows
• Ability to work collaboratively as a member of an interdisciplinary team and establish and maintain effective working relationships with other healthcare professionals, practitioners, patients and families.
• Makes recommendations on system improvements to streamline clinical review processes, participates in the implementation of such optimizations and takes a leading role in staff retraining, when applicable
• Provides education on Program guidelines and coverage determination to interdisciplinary teams.
• Other duties as assigned Requirements:

 

• Education Requirements Associates degree (Bachelor’s degree preferred)
• 3+ years of retail pharmacy technician experience or related health care administrative, and a strong familiarity with the prior authorization process preferred. Working knowledge of third party payer plans and how they are processed, of medication reimbursement, including the prior authorization process, proficiency in the procurement of financial assistance for patients with government-sponsored health plans including Medicare , Medicaid and TriCare.

Preferred:

• 3 years of health care related billing and benefits investigation
• 1 year of retail pharmacy experience
• 1 year of PBM payer operations
• 1 year of hospital/institutional pharmacy

 

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