Pharmacy Tech - Benefits & Auth Coordinator

At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team.

Job Summary

The Specialty Prescription Coordinator is responsible for prescription order entry, insurance verification, adjudication of claims, completing prior authorization process and coordination of pharmacy financial assistance. In addition, this role provides customer service as a resourceful point of contact for patients and providers by reviewing patient profiles, scheduling new prescription and refill deliveries, and collecting key clinical information.

Job Description

Minimum Qualifications

Education: High school diploma or GED.

Licenses/ Certifications: Licensed as a registered Pharmacy Technician or Pharmacist Intern in the State of Texas.

Experience / Knowledge / Skills:

• Three (3) years experience in specialty, retail, mail order, or hospital pharmacy.

• Two (2) years experience in insurance verification, benefits, and eligibility investigations.

• Demonstrated attention to detail in completing tasks and communication with patients and healthcare providers on the phone.

• Ability to efficiently complete multiple daily work assignments while operating independently.

• Ability to work cross-functionally to solve problems and improve quality and service

• Knowledge of medical and pharmaceutical terminology and pharmaceutical patient assistance programs.

• Demonstrated experience in customer service with strong interpersonal and communication skills.

• Functional skills with the Microsoft Office Suite of products (Outlook, Excel, Word, PowerPoint).

• Experience in specialty pharmacy or pharmacy benefit management strongly preferred.

Principal Accountabilities

• Enters prescriptions and processes claims accurately, for new/refill prescriptions. 

• Clarifies prescription orders with pharmacist and/or clinician as appropriate.

• Conducts insurance benefit investigation to obtain patient’s current eligibility and coverage information; communicates with patient and caregiver and/or physician office regarding insurance investigation and patient financial responsibility.

• Troubleshoot and resolve billing rejections and subsequently rebill claims to appropriate carrier for all insurance plans.

• Submit prior authorization requests, follow up on submitted prior authorization requests and submit claims with approvals as appropriate.

• Confirms and processes payment information and assists patients with appropriate forms of pharmacy financial assistance, when appropriate.

• Provides customer service to patients by conducting inbound and outbound calls to schedule delivery of medications. Tracks packages to ensure patient receives medication in a timely manner.

• Collects clinical information essential for patient management; notifies clinical staff with any patient side effects and/or requests from the patient or caregiver; provides status updates to physician offices when appropriate; notifies and communicates instructions to patients in the event of a medication recall.

• Assists with process of prescription and payer audits in accordance with company policy. 

• Completes and maintains all required documentation in pharmacy information systems and the patient’s record.

• Communicates with various pharmacy team members as needed to coordinate timely prescription dispensing and reports errors, omissions, or incidents to pharmacist. Works proactively to solve issues that may arise.

• Participates in staff meetings and helps with special projects.

• Maintains productivity rates and meets quality expectations determined by management. 

• Complies with all regulatory requirements, including HIPAA/HITECH.

• Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.

• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.

• Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann’s service standards by providing safe, caring, personalized and efficient experiences to patients and colleagues.

• Other duties as assigned.