Required Population Served Job Responsibilities Job Responsibilities • Conducts the benefits investigation process, including coordination with payers to investigate and verify terms of patient coverage and out-of-pocket costs • Provide timely and accurate information regarding coverage and cost to patients and BSP team members • Initiate and manage prior authorization process for new specialty prescriptions and prospectively track expiring authorizations, obtaining renewals as needed to prevent gaps in treatment • Support BSP pharmacists to manage the appeals process for patients and ensure timely communication occurs • Understand The Centers for Medicare & Medicaid Services (CMS) regulations and billing guidelines and complete required training pursuant to BSP policies and procedures (e.g., fraud, waste, and abuse training) • Answer insurance and billing questions and provide feedback to management regarding contracting opportunities and process improvements • Obtain all necessary paperwork and financial information needed for patients seeking financial assistance • Conduct research on all available sources of funding and resources available for each particular BSP patient scenario • Responsible for daily billing operations, such as submission of claims (electronic and paper), patient statements, follow-up and resolution of nonpayment, denials, and prior authorization requests • Work timely to resolve urgent requests from patients, caregivers, and medical/nursing staff • Process new and refill prescriptions accurately, through the proper use of equipment and techniques, based on BSP policies and procedures for prescription entry and dispensing • Provide superb customer service when communicating with patients and when communicating with medical/nursing staff to obtain key information needed to allow for dispensation of medication • Monitor required areas for outdates, cleanliness, organization, and drug/supply stock levels • Maintain, purchase and organize inventory supply in a manner which minimizes inventory storage cost, wastage, and stock-outs • Ensure inventory is rotated properly, stored in appropriate conditions and location with 100% accuracy • Prepare medication in a manner that minimizes cost due to wastage • Participate in departmental process or quality improvement initiatives. • Understand and maintain all federal and state regulations and policies and procedures applicable to HIPAA practices and patient confidentiality • Document all activity and communication within designated documentation system • Interact with patients over the phone to coordinate prescription refill(s), specialty prescription deliveries, maintain updated billing information and patient address • Complete special projects as assigned by supervisor Specifications Experience Description Minimum Required Preferred/Desired 5 years experience in outpatient pharmacy or clinic setting Education Description Minimum Required Preferred/Desired Training Description Minimum Required Preferred/Desired Special Skills Description Minimum Required Preferred/Desired Licensure Description Minimum Required Preferred/Desired Valid Pharmacy Technician License in TN and Pharmacy Technician Certificate (CPhT) Reporting Relationships Does this position formally supervise employees?