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It's more than a career, it's a callingMO-SSM Health DePaul Hospital - St. LouisWorker Type:RegularJob Highlights:This is a full-time, day-shift position working Mon- Fri from 8:30am5pm. (no weekends!).Ideal candidate will be very organized, able to work in a fast-paced environment and have experience with Medicare Medicaid and Commercial insurance billing. Experience with Med Bill is a huge plus.You will be working with other staff including nurses, providers and pharmacists so excellent communication skills is a must. Must be comfortable working in Behavioral health, be compassionate and a multi-tasker.Job Summary:Increase patient access and adherence to medically necessary pharmaceuticals by managing patient’s insurance benefits and utilizing established patient assistance programs. Provides value-added services by developing client-based relationships with clinical staff and patients, presenting pharmacy service options through customized financial analysis, and facilitating information gathering for program enrollment (patient assistance and indigent programs).Job Responsibilities and Requirements:PRIMARY RESPONSIBILITIES
Serves as the liaison between the medical staff, outpatient pharmacies, insurance providers and patients to improve communication and continuity of care.
Review patient demographics, medication history, and insurance status to identify socioeconomic barriers, opportunities for intervention and eligibility for prescription assistance.
Improves patient service experience through the provision of benefits investigations and conducting prior authorization services. Develops a thorough understanding of payer reimbursement and patterns for pharmacy and medical claims with third parties.
Serves as primary ambulatory pharmacy resource to facilitate access to prescription and medical benefit medications. Including but not limited to; formulary/coverage issues, copay issues, patient assistance program eligibility, and other indigent programs.
Coordinates services with appropriate departments and internal patient care team members regarding patients who have limited financial resources for paying for medications and facilitates medication access to support discharge preparations.
Interacts with hospital and clinic employees, including but not limited to pharmacists, clinical staff, fiscal personnel, department managers, access services staff, coding staff, and billing assistants. External contacts include but are not limited to third party payers, manufacturers, prescription benefit management companies, external pharmacy personnel, and referring providers and their support staff.
Reviews complex insurance situations in order to educate patients, providers, and clinic staff on how to follow appropriate next steps to get access to prescription and medical benefit information.
Performs other duties as assigned.
EDUCATION
Bachelor's degree or equivalent years of experience and education
EXPERIENCE
No experience required
PHYSICAL REQUIREMENTS
Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs.
Frequent sitting, standing, walking, reaching and repetitive foot/leg and hand/arm movements.
Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors.
Frequent use of hearing and speech to share information through oral communication. Ability to hear alarms, malfunctioning machinery, etc.
Frequent keyboard use/data entry.
Occasional bending, stooping, kneeling, squatting, twisting and gripping.
Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs.
Rare climbing.
Licenses / Certifications:FUTURE - Pharmacy Technician, Registered within 2 months - Illinois Department of Financial and Professional Regulation (IDFPR), FUTURE - Pharmacy Technician, Registered within 6 months - Missouri Division of Professional Registration, MO Registration Application and Finger Print Process Complete AT TIME OF HIRE - Missouri Division of Professional Registration, Pharmacy Technician, Registered - Illinois Department of Financial and Professional Regulation (IDFPR), Pharmacy Technician - Missouri Division of Professional RegistrationWork Shift:Day Shift (United States of America)Job Type:EmployeeDepartment:3931000128 Pharmacy Concierge ServiceScheduled Weekly Hours:40SSM Health is an equal opportunity employer. SSM Health does not discriminate on the basis of race, color, religion, national origin, age, disability, sex, sexual orientation, gender identity, pregnancy, veteran status , or any other characteristic protected by applicable law. Click here to learn more. (https://www.ssmhealth.com/privacy-notices-terms-of-use/non-discrimination?ga=2.205881493.704955970.1667719643-240470506.1667719643)
