Assists the specialty pharmacist and team with processes required to dispense high dollar specialty medications for chronic diseases, such as rheumatoid arthritis, psoriasis, osteoporosis, oncology, obesity, multiple sclerosis, etc.
Manages phone calls from patients, providers, insurance companies, and third parties. Schedules and coordinates appointments with patients. Provides exceptional customer service. Contacts providers for new prescriptions, refills, insurance issues, and follow-ups as needed. Contacts insurance companies for eligibility, coverage information, and overrides. Works efficiently in multiple online portals and electronic medical records (Sharp, UnitedHealthCare, EPIC, BlueShield, FexEx, RightFax, Covermymeds, Cerner, Rx30, Onco-EMR, etc.) to verify insurance eligibility, referrals, CPT codes, provider notes, diagnoses, extensions, labs, coverage information (deductible, copay, etc.). Ability to multi-task.
Prepares, organizes, updates, and maintains various databases and lists (weekly refill, referrals, deductibles, etc.). Ensures referrals are in date and refills obtained. Follows up as needed. Assists with data entry, filing, and document preparation. Collects, inputs, organizes, and prepares electronic patient charts, folders, collaborative practice agreements. Assists patients with manufacturer copay assistance programs, Processes, adjudicates, prepares, packages, labels, and sells prescriptions. Follows up on prescriptions that have not been picked up as scheduled. Operates a cash register. Prepares specialty medications for FedEx shipment to patients. Generates, prints, and tracks FedEx labels and medication deliveries. Follows up with patients to confirm delivery and receipt. Works with FedEx to resolve delivery issues. Regularly responds to emails and electronic faxes. Assists with updates to quarterly drug pricing sheets for specialty pharmacy medications from Cardinal. Assists with specialty pharmacy billing and reconciliation. Logs and tracks pharmacy and medical claims. Completes 1500 claim forms. Works closely with other providers and organizations to verify and reconcile billing claim issues. Maintains and orders specialty pharmacy supplies. Communicates and collaborates with specialty pharmacists, specialty technicians, outpatient pharmacy team members, greater Palomar Health team members, providers, third parties, insurance representatives, and patients. Additional responsibilities: must be willing to work within other departments of the pharmacy, including, but not limited to the retail pharmacy sector of the PMC Outpatient Pharmacy at Palomar Medical Center Escondido and the PHMG Coumadin Clinic located at the Poway Outpatient Pavilion. Replenishes pharmacy supplies, such as paper, labels, ice packs, cooler boxes, vials, caps, bottles, etc, which may involve lifting up to 50 pounds.
Works collaboratively. Fosters a fair, ethical, safe, clean, and inclusive work environment.
Performs other duties as assigned: Complies with local, state, and federal regulations. Understands and adheres to Health Insurance Portability and Accountability Act (HIPAA) regulations Follows Palomar Health rules, policies, procedures, applicable laws and standards. Carries out the mission, vision, and quality commitment of Palomar Health.

 

Job Requirements