Pharmacy Benefits Specialist

General Summary: A nonexempt position responsible to coordinate the activity of pharmaceuticals, such as Xolair, for the practice. These responsibilities will include: Appointment scheduling; Obtaining prior authorizations; Ordering; Inventory tracking & reconciliation; Collecting patient-due amounts; and other needed tasks

Essential Job Responsibilities:

• Determine if the pharmaceutical should be handled as Buy & Bill or Specialty Pharmacy
• Obtain pre-authorization for drug purchase
• Order pharmaceutical from the drug company
• Assist patient with copay assistance
• Provide estimates to patients on their financial responsibility
• Checks and balances to verify that we are ordering and billing correctly
• At the end of each day run scheduling and charge reports to ensure that Buy & Bill and Specialty Pharmacy injections have been billed appropriately
• Collect patient-due amounts
• Accounts Receivables - follow up, denials monitoring and appeals
• Monitor and track drug inventory per location
• Other tasks as requested by supervisor

Education: High school diploma or equivalent.

Experience: At least 1 year of insurance verification, and charge auditing

Other Requirements: None

Performance Requirements:

Skills:

• Ability to multi-task
• Attention to detail
• Ability to read accounts and understand medical terms
• Excellent customer service and communication skills
• Exhibit high level of professional behavior
• Ability to learn quickly and work well under pressure
• Ability to work independently and as a team

Equipment Operated: Standard office equipment including computers, fax machines, copiers, printers, telephones, etc.

Work Environment: Position is in a well-lighted office environment.

Mental/Physical Requirements: Involves sitting approximately 90 percent of the day, walking or standing the remainder.