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 patient’s 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 assistance
25. Follows policies, procedures, and guidelines set forth by the CARTI Dispensing Program.
26. Provides oversight of the PDP assistance programs and reviews by the accounting department. Optimizes patient assistance.
27. Creates and maintains Standard Operating Procedures for each assistance program based on criteria and internal departmental processes
28. Stays current with new drug releases, their purpose, and obtains information on any assistance programs associated with the drug
29. Documents clear, concise, and complete notes in appropriate systems promptly.
30. Notify the Director of Pharmacy or pharmacist of any issues immediately.
31. Maintain sample inventory. Properly dispense samples from inventory to physicians at the physician teams’ request.
32. Must be willing to train and help with certain duties in the chemo mixing services area as time permits.

EDUCATION, CERTIFICATION, LICENSURE, and REGISTRATION:

1. High School Diploma or equivalent
2. Pharmacy Technician License and/or Certification (certification must be applied for and obtained within 3 weeks of employment)

EXPERIENCE, KNOWLEDGE, SKILLS, and ABILITIES:

1. Minimum 2 years of experience in a retail pharmacy
2. Knowledge of private payers, Medicare, Medicaid, marketplace, commercial and alternate funding sources and reimbursement processes

REASONING ABILITY:

1. Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
2. Ability to interpret a variety of instructions furnished in written, oral, or schedule form.

INTERPERSONAL SKILLS:

1. Must interact and communicate both verbally and in written form.
2. Must interact and exchange information regarding patients with physicians and other departmental personnel, and outside agencies on a frequent basis while respecting the confidentiality of patient information.

PHYSICAL DEMANDS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

1. While performing the duties of this job, the employee is regularly required to talk or hear.
2. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
3. Specific vision abilities required by this job include close vision and the ability to adjust focus.

WORK ENVIRONMENT:

The work environment described here are representative of those an employee encounters while performing the essential functions of this job.

This position involves potential exposure to infectious diseases. Colleagues are offered appropriate vaccinations and safety training.

COMMENTS:

This description is intended to describe the essential job functions, the general supplemental functions and the essential requirements for the performance of the job. It is not an exhaustive list of all duties, responsibilities and requirements of a person so classified. Other functions may be assigned and management retains the right to add or change the duties at any time. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job.

This position is a Safety Sensitive Position. The essential functions, physical demands, and mental competencies of this job require the employee maintain the ability to work in a constant state of alertness in a safe manner.