Lead Pharmacy Business Coordinator - Infusion

Lead Pharmacy Business Coordinator - Home Infusion

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Responsible for assisting with the training of new employees hired into the department or organization, as well as involvement in departmental and/or organizational committees for process improvement, operational efficiency, and financial accountability. Also, responsible for conducting payer discussions, in-house financial audits, payer performance compliance, prepayment claims audit, CMS CERT audits, CMS Fraud, Waste, & Abuse audits, and auditing 3rd party payer compliance.

They must maintain knowledge of revenue cycle operations, third party reimbursement procedures & regulations, payer relations, claims adjudication, contractual claims processing, medical terminology, and an understanding of the 340B Drug Discount Program. Knowledge will include at minimum, all aspects of payer relations, claims adjudication, contractual claims processing and general reimbursement procedures. Provides customer support and resolves problems that may arise because of customer inquiries.

Supports the work of the department by completing reports and performing clerical duties as needed. Responsible for performing pharmacy related functions in compliance, outcomes, operations, and clinical areas with departmental policies and procedures that provide optimal pharmaceutical care.

Additionally, the Lead Pharmacy Business Coordinator may be responsible for securing registration data based upon comprehensive data elements, financial education/counseling, insurance verification, provision of clinical information for pre-certification, authorization, and third-party claims management. Interviews patient and arranges alternate methods of payment. Ability to calculate patient co- payments and deductibles based upon benefits processing, as well as assisting with financial assistance policies offered through the department and/or organization.

Last, they will support the Business team members needs, tasks, and operation in absence of the Manager.

• Bachelor’s Degree OR Nationally Certified Pharmacy Technician (PTCB or EXPT) upon hire
• Pharmacy Business, Finance, Billing, or Reimbursement Certifications from an accredited organization such as ASHP, HFMA, or PTCB.
• Three years pharmacy experience. Experience in training, leadership, or other related specialized experience required.

• PTCB Advanced Pharmacy Technician Certificate
• Masters in Business Administration or Finance
• Two (2) years working in a Specialty Pharmacy or Home Infusion Pharmacy
• Two (2) years Leadership experience

• Drafts various correspondence letters and sends to referral source when necessary.
• Gathers and documents demographics, insurance information, needs assessment, and other data as needed.
• Provides information and answers to patient/caregiver questions and refers to clinician when appropriate or requested.
• Identifies all patients requiring pre-certification or pre-authorization at the time services are requested or when notified by another hospital or clinic department.
• Enters pre-registration using the comprehensive data elements into the registration/billing.
• Contacts insurance company or employer to determine eligibility and benefits for requested services.
• Performs medical necessity screening as required by third party payers.
• Identifies managed care admission/treatment requirements and assures the requirements are met to guarantee payment of the account.
• Initiates charge anticipation calculations. Accurately identifies anticipated charges to assure identification of anticipated self-pay portions.
• Communicates with the patient the anticipated self-pay portion (co-payments/deductibles/co-insurance) and establishes payment arrangements based on the Financial Policy and documents the financial resolution in the registration/billing…