Registered Pharmacy Technician - Pharmacy Care Coordinator

SHIFT:

Day (United States of America)

Seeking Breakthrough Makers

Children’s Hospital of Philadelphia (CHOP) offers countless ways to change lives. Our diverse community of more than 20,000 Breakthrough Makers will inspire you to pursue passions, develop expertise, and drive innovation.

At CHOP, your experience is valued; your voice is heard; and your contributions make a difference for patients and families. Join us as we build on our promise to advance pediatric care—and your career.

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A Brief Overview

The Registered Pharmacy Technician - Pharmacy Care Coordinator (PCC) ensures timely patient access to medication therapies by managing benefit verification, prior authorizations, reauthorizations, and appeals. This role will handle inbound calls (may include serving as a call center resource), triaging issues, providing explanations of benefits structures and copay assistance programs, and resolving complex coverage barriers. The PCC partners closely with patients, providers/clinic staff, payors, and internal and/or external pharmacies, while accurately documenting all activity in the electronic health record (EHR) through final authorization determination. Working under the supervision of a licensed pharmacist, the Registered Pharmacy Technician – PCC performs prescription intake, insurance verification and entry, billing and/or adjudication support, medication preparation, dispensing, and refill coordination and medication delivery activities. This position will cross cover other areas as needed.

What you will do

• 1. Receive and process new, refill, electronic, faxed, and transferred prescriptions by entering and maintaining accurate prescription and patient records (by verifying demographic, insurance information, or proper study identification) in EHR and/or pharmacy dispensing system.
• 2. Support refill coordination activities, including contacting patients or caregivers, scheduling deliveries, and escalating any issues to pharmacist for review or intervention according to departmental policies and procedures.
• 3. Accurately document all actions, communications, and follow up activities in EHR and/or pharmacy dispensing software to support continuity of care and regulatory compliance
• 4. Prepare and fill prescriptions by selecting appropriate products and NDCs, counting or measuring medications, labeling packages, and applying auxiliary labels in accordance with enterprise and departmental policies and procedures, federal and state laws and regulatory or accreditation standards.
• 5. Verify pharmacy and/or medical benefits using third party benefit coverage/authorization vendors to determine pharmacy eligibility and appropriate dispensing pharmacy.
• 6. Perform billing and/or claim adjudication and identify coverage status, payor restrictions, servicing pharmacy options, and determine next steps for order escalation as needed including but not limited to: Prior Authorization, Benefits Investigation, Step Therapy, Non-Formulary, Financial Assistance, and Copay-assistance programs.
• 7. Submit, track, and follow up on prior authorizations, reauthorizations, and appeals in accordance with payor specific requirements.
• 8. Follow up with insurance companies, providers/clinic staff and patients/families regarding therapies that are identified as ineligible or non-covered.
• 9. Contact provider/clinic staff with all information that requires follow-up.
• 10. Answer inbound calls (may include serving as a call center resource) and triaging patient, provider, and payor inquiries to the appropriate teams.
• 11. Coordinate with provider/clinic staff, pharmacies, and payors to ensure continuity of care and timely access to therapy.
• 12. Introduce and explain scope of Pharmacy services (including medication history, refill coordination, access to emergent services, and pharmacist escalation as appropriate) and communicate authorization status, coverage limitations, and outstanding financial obligations if appropriate, and next steps clearly to patients, families, and providers/clinic staff.
• 13. Electronically collect or facilitate payment of outstanding balances when applicable.
• 14. Accurately document all activities, communications, and determinations in the EHR.
• 15. Refer eligible patients to CHOP’s comprehensive pharmacy program that includes retail, specialty and home infusion pharmacies and