Pharmacy Referral Specialist
Ada, OK
Full Time
Entry Level
POSITION TITLE: Pharmacy Referral Specialist
DEPARTMENT: Compliance
NATURE OF POSITION: The Pharmacy Referral Specialist is an integral member of the interdisciplinary health team and assumes responsibility for medical records maintenance according to departmental guidelines. Position is also responsible for and will assist with pharmacy billing operations.
MINIMUM QUALIFICATIONS:
- High School graduate or equivalent required
- Must be at least 18 years of age
- Medical/Dental office experience preferred
- Customer service experience required
- Ability to work and communicate with a multidisciplinary healthcare team and the public
- 2+ years of experience working in Microsoft office, specifically Microsoft Excel (using filters, sorting, conditional formatting, and basic formulas), Microsoft Outlook, and Microsoft Word preferred
- Basic computer skills required
- Phone etiquette
- Must be able to sit, stand, walk, bend, and/or lift for extended periods of time
RESPONSIBILITIES:
- Protects the confidentiality of the patient and their records at all times by complying with the COFMC Patient Confidentiality and HIPAA policies/procedures
- Maintains a high level of confidentiality by not discussing patient information, except when it directly relates to the case of the patient
- Responsible for proper maintenance of all referral records.
- Tracks and follows up on incoming referral records.
- Review and screen patients to determine if patients have adequate prescription coverage. Refer appropriate patients to financial counseling for coverage or charity application.
- Provide customer service via phone and triage patient calls to an appropriate party.
- Troubleshoot and resolve billing rejections and subsequently rebill claims to appropriate carriers for all commercial, federal, and state insurance plans. Submit prior authorization requests, follow up on submitted prior authorization requests and submit claims with approvals as appropriate.
- Contact payers for lost medication overrides, replacement, and vacation override approvals.
- Assist with prescription audits.
- Establish and maintain good working relationships with all billing specialists and all other staff members to maintain effective communication regarding third-party billing issues.
- Assist in the development, implementation, and evaluation of third-party billing policies and procedures. Educate pharmacy staff about third-party billing policies and procedures as needed.
- Performs other duties as assigned.
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