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Exemption Status:

Non-Exempt

Schedule Details:

Monday through Friday

Scheduled Hours:

8a - 430p

Shift:

1 - Day Shift, 8 Hours (United States of America)

Hours:

40

Cost Center:

99940 - 5479 Financial Clearance PAC

Union:

SHARE (State Healthcare and Research Employees)

This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.

Everyone Is a Caregiver

At UMass Memorial Health, everyone is a caregiver – regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 16,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day.

Under the direct supervision of the Revenue Cycle Financial Clearance supervisor is responsible to perform a variety of complex duties within the Financial Clearance department. Performs authorization related tasks such as submission, denial resolution and running of test claims to ensure the timely authorization of medication.

I.             Major Responsibilities:

Process medication authorizations requests, ensuring that appropriate and complete clinical documentation is supplied at time of submission. Review of payer denial letter to determine options available to obtain approval or recommend covered alternative. Ability to problem solve and investigate problem denials and provide clear instruction to the clinical team on action needed. Responsible for running test claims in Epic to assist the team with medication denials or rejections. Communication with outside retail pharmacies in order to resolve medication authorization issues and avoid delays. Interacts with providers and provider staff to resolve retail medication authorization denials or issues. Resolves common adjudication issues and troubleshoots with insurance when necessary. Follows departmental workflows and policies. Answers and responds to provider and patient telephone calls. Must work a minimum of one (1) shift per month in a UMMMC outpatient pharmacy. Participates in identifying problems or areas for improvement and assists supervisor with problem solving projects and improving operations. participates in Continuous Quality Improvement activities and/or teams.

Standard Staffing Level Responsibilities: 

1.            Complies with established departmental policies, procedures, and objectives.

2.            Attends variety of meetings, conferences, seminars as required or directed.

3.            Demonstrates use of Quality Improvement in daily operations.

4.            Complies with all health and safety regulations and requirements.

5.            Respects diverse views and approaches, demonstrates Standards of Respect, and contributes to               creating and maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors.

6.            Maintains, regular, reliable, and predictable attendance.

7.            Performs other similar and related duties as required or directed.

All responsibilities are essential job functions.

II.            Position Qualifications:

License/Certification/Education:

Required:

High school diploma or equivalent.  Current license with the Massachusetts Board of Pharmacy.

License must be maintained and current.

Certified by one of the national governing bodies such as PTCB, or the National Healthcareer Association ExCPT. 

Certification must be maintained and current.

Experience/Skills:

Required:

Previous pharmacy technician experience, preferably in a retail pharmacy setting. Position requires proficiency in math and, knowledge and ability to use a computer.  Must be able to follow oral and written instructions with accuracy, efficiency, and dependability.  Positive work ethic, motivated and professional demeanor