To facilitate enrollment and assist patients enrolled in the Specialty Pharmacy in navigating the complexities of their insurance benefits and additional resources, in order to increase access to and to minimize patient out-of-pocket expense on important specialty medications.
Key responsibilities and accountabilities may include:
1.Obtain detailed insurance benefit information including but not limited to; appropriate billing information (medical vs prescription covered benefit), retail and mail order prescription co-pays, network pharmacies, plan formulary, prior authorization requirements, and other necessary information to successfully adjudicate a specialty medication claim.
2. Evaluate patients’ medication, insurance, and financial situation and counsel them regarding their prescription insurance coverage, benefits, and related requirements, as well as evaluate the resources available through various channels (insurance, drug manufacturers, charity care, etc) to ensure affordable access to specialty medications.
3. Evaluate medication orders to determine appropriate interventions, including prior authorizations, appeals and financial assistance.
4. Assist patients with the necessary documentation needed to apply for extra help, charity care, manufacturer drug assistance, Medicaid, and/or other qualifying insurance or assistance programs. Maintain regular contact with patients to ensure smooth and timely transition into these programs, with minimal to no interruption in therapy.
5. Proactively monitor patients’ insurance for changes in benefits and coverage, update billing information in appropriate systems when necessary, and maintain consistent communication with the patient as needed.
6. Review Work Queues in MiChart for billing questions, errors or high balances. Troubleshoot complex billing issues (insurance/prior authorization, coordination of benefits, etc) and resolve them.
7. Document all patient interactions in appropriate systems and databases, including MiChart, TheraDoc, Otis and QS1.
8. Act as a resource and effectively communicate complex insurance and financial information associated with specialty medications to all areas within the medical center including clinics and providers as well as insurance companies, patients, and their families. Participate in patient education programs, including group classes and one on one teaching.
9. Facilitate patient enrollment or transition to a non-UMHS pharmacy when needed based on patients’ preference or insurance requirements to ensure uninterrupted access to their specialty medication.
10. Stay abreast of current regulations and requirements of insurance companies, assistance programs and other medication resources
11. Identify, develop and implement additional projects and process improvements including LEAN projects in cooperation with the PFC team, Specialty Pharmacy team and any other team involved.
12. Update and maintain policies and procedures including training materials and check lists.
13. All other duties as assigned.
For more information about the UMHS Department of Pharmacy Services, see our annual report at: https://www.medicine.umich.edu/dept/pharmacy/pharmacy-annual-report
Minimum one year experience in a pharmacy or medical office setting with background in insurance benefits, billing and verification, and patient financial counseling.
Excellent written and verbal communication skills.
Must be able to prioritize with accuracy and dependability
Bachelor or associate degree in a healthcare-related field or 3-5 years experience in a pharmacy or medical office setting.
Ability to work well in a team as well as independently with minimal supervision, consistently problem solving and managing time in an efficient and productive manner.
Knowledge of medical and prescription insurance company policies and requirements (i.e. Medicare, Social Security, Medicaid, and Medicare Part D).
Ability to handle fast-paced, time-sensitive information while maintaining strict patient confidentiality
Michigan Medicine conducts background screening and pre-employment drug testing on job candidates upon acceptance of a contingent job offer and may use a third party administrator to conduct background screenings. Background screenings are performed in compliance with the Fair Credit Report Act.
Michigan Medicine improves the health of patients, populations and communities through excellence in education, patient care, community service, research and technology development, and through leadership activities in Michigan, nationally and internationally. Our mission is guided by our Strategic Principles and has three critical components; patient care, education and research that together enhance our contribution to society.
Job openings are posted for a minimum of seven calendar days. This job may be removed from posting boards and filled anytime after the minimum posting period has ended.
U-M EEO/AA Statement
The University of Michigan is an equal opportunity/affirmative action employer.