The University of Kansas Health System · 19 hours ago
Specialty Pharmacy Patient Financial Counselor - Hybrid
Lenexa, KS
Full-time
Hybrid
Entry, Mid Level
1+ years expThe University of Kansas Health System is seeking a Specialty Pharmacy Patient Financial Counselor to join their growing Pharmacy team. This role is responsible for acting as a financial advocate for patients regarding access to their specialty prescription medications, ensuring proper billing, and assisting with copay and free drug options for patients.
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Responsibilities
Effectively gathers patient information to complete a specialty prescription benefits investigation within a specified time frame
Interpret, comply, and communicate Medicare/Medicaid rules and regulations, when appropriate
Ensures appropriate billing of all specialty prescription medications including the completion of any required insurance authorizations using information in the medical record to satisfy the insurance requirements
Follows up with insurance companies on denials and insurance inquiries as necessary to resolve the account within a specified time frame
Provides additional information or documentation as needed to resolve account
Seeks out copay assistance for specialty prescriptions and applies on behalf of the patient when possible. Requires review of patient’s financial documents and coordination of necessary application materials, as appropriate
Follows up with copay assistance foundations to ensure applications are reviewed and processed in a timely manner. Provides any additional information as necessary to resolve the account within a specified time frame
Communicates payer trends to management
For uninsured and underinsured patients with no other copay assistance options, seeks out free drug from available manufacturer programs and applies on behalf of the patient. Requires review of patient’s financial documents and coordination of necessary application materials, as appropriate
Follows up with manufacturer programs to ensure applications are received and being processed
Documents all activities within the electronic medical record per department policy
Proactively contacts the patient or family by phone or electronically (email, electronic health record) to ask questions about prescription coverage and financial information (when needed). When delays occur, ensures patient or patient’s caregiver understands the reason for delay and what information or actions are needed to fill the prescription
Uses critical thinking skills to effectively solve problems. Understands when to escalate issues to leadership
Communicates effectively with pharmacists and clinic staff to discuss and address any insurance issues or other issues requiring resolution that prevent a patient from receiving their prescription in a timely manner
Receives and resolves patient billing questions and complaints in a compassionate, courteous, professional, and timely manner
Takes actions to resolve issues such as denials, changing insurance, re-filing claims, calling insurance companies or answering questions
Identifies and participates in continuous improvement opportunities and assists with implementing departmental planning and process improvements
Demonstrates the ability to effectively communicate with patients and insurance companies regarding sensitive financial matters
Assists with training of new team members as requested by leadership
Process statements, payments, refunds and adjustments to patients and insurance companies through point-of-sale system, when necessary
Review and analyze monthly reports, data and trends for improvement opportunities and communicate to leadership
Must be able to perform the professional, clinical and or technical competencies of the assigned unit or department
Qualification
Required
High School Graduate plus 3-year of experience in specialty pharmacy, medication assistance, prior authorizations, pharmacy benefits investigation, managed care, financial advising, claims processing, collections, or revenue cycle positions
Associates Degree in a related field of study from an accredited college or university plus 1-year of experience in specialty pharmacy, medication assistance, prior authorizations, pharmacy benefits investigation, managed care, financial advising, claims processing, collections, or revenue cycle positions
Must be able to type 45 wpm
1 or more years of experience using Microsoft Word, Excel or a related computer program
Kansas Pharmacy Technician within 60 days of hire (Registration includes application with state board of pharmacy)
Demonstrates strong oral and written communication skills
Ability to multi task, prioritize, and escalate
Demonstrated good oral and written skills
Knowledge of Insurance (Commercial & Government)
Knowledge of how to navigate payor websites
Working knowledge of CMS regulations as applicable to Medicare Part B and D plans
Epic experience
Customer service experience
Company
The University of Kansas Health System
The University of Kansas Health System is an academic medical center for complex care and diagnosis.
10001+ employees
Funding
Current Stage
Late StageTotal Funding
unknownKey Investors
Parkinson's Foundation
2023-07-25Grant
Leadership Team
Tammy Peterman
President, Kansas City Division, Executive VP/Chief Operating Officer and Chief Nursing Officer
Recent News
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