Eligible for $3000 sign on, if external
Full Time Benefits
Receives and processes prescription referrals received by the Specialty Pharmacy including data entry, insurance processing, and prior authorization completion for specialty medications. Understands pharmacy benefit and medical benefit claims submission process for reimbursement of prescription medications. Communicates with patients/caregivers, insurance company representatives, and other members of the healthcare team for patients to initiate and continue therapy.
Why UnityPoint Health?
Visit us at UnityPoint.org/careers to hear more from our team members about why UnityPoint Health is a great place to work.
Essential functions are the duties and responsibilities that are essential to the position (not a task list). Do not include if less than 5% of work time is spent on this duty. Be specific without giving explicit instructions on how to perform the task. Do not include duties that are to be performed in the future. Duties should be action oriented and avoid vague or general statements.
% of Time
Daily work assignments
· Looks at the individual needs of each patient/customer and matches those needs to the many services UnityPoint at Home has to offer; utilizes other members of the home care coordination team as necessary to coordinate services outside of the specialized service line.
· Processes all incoming prescription orders; obtains demographic, financial, and other qualifying data to verify benefits and obtain authorization for specialty medications.
· Processes test claims of health system’s specialty pharmacy prescriptions through pharmacy dispensing software to determine available pharmacy options through patient insurance plans. Communicates/coordinates with patients/caregivers and members of the healthcare team appropriate actions based on patients’ benefits.
· Specializes in specialty pharmacy service line yet is responsible for having a basic knowledge of all service lines.
· Initiates and coordinates prior authorization requests to third party payers and maintains a working knowledge of third-party payer guidelines. Follows up with third party payers as necessary.
· Collects insurance information, runs test claims, obtains medical records as required for completion of prior authorizations.
· Re-verifies eligibility and benefits when patient starts a new benefit year.
· Provides customer service to patients and physicians’ offices and coordinates the delivery of medications with patients/caregivers and/or members of the healthcare team via inbound and outbound calls, email, and other electronic messaging.
· Operates pharmacy dispensing software and health system electronic health record to record, document, and retrieve pertinent medical information within the patients’ electronic medical record to ensure appropriate agency services are provided in a timely manner.
· Establishes and maintains positive working relationships with current and potential providers and referral sources.
· Upholds expectations and perceptions of UPAH as a high-quality provider of services by maintaining excellent customer service.
· Maintains a working knowledge of relevant regulations affecting patients and the operation of our business.
· Performs patient follow up phone calls as directed by manager or supervisor.
· On-call duties may be required on a rotation basis, including weekends and holidays.
· Prohibited from conducting evaluations or interpreting any clinical decision. Refers clinical questions to appropriate staff.
Other job duties
· Performs other duties specific to some service lines.
· Maintains regular and consistent attendance at work.
· Behaves in a manner consistent with company mission, vision, and value statements.
· Maintains compliance with OSHA, accreditation standards and risk management guidelines.
· Maintains compliance with personnel policies and procedures.
· Behaves in a manner consistent with all corporate compliance policies and procedures.
· Performs other duties as requested by the Specialty Pharmacy Manager or supervisor to facilitate the smooth and effective operations of the organization.
· Meets measures as determined and required for job productivity and performance improvement.
· Employee is responsible for completion of communication tasks and activities in a timely manner. This would include, but is not limited to: responding to email and voicemail messages promptly, accurately, and professionally; attending staff meetings as scheduled or viewing recordings of those meetings if available; asking questions of team members and supervisors when needing clarification about various day-to-day issues or patient needs; and reviewing employee communication pieces to stay aware of UnityPoint at Home programs and initiatives.
Basic UPH Performance Criteria
· Demonstrates UnityPoint Health Values and Standards of Behaviors as well as adheres to policies and procedures and safety guidelines.
· Demonstrates ability to meet business needs of department with regular, reliable attendance.
· Employee maintains current licenses and/or certifications required for the position.
· Practices and reflects knowledge of HIPAA, URAC, ACHC, OSHA and other federal/state regulatory agencies guiding healthcare.
· Completes all annual education and competency requirements within the calendar year.
· Is knowledgeable of department compliance requirements for federally funded healthcare programs (e.g. Medicare and Medicaid) regarding fraud, waste, and abuse. Brings any questions or concerns regarding compliance to the immediate attention of administrative staff. Takes appropriate action on concerns reported by department staff related to compliance.
Disclaimer: This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Other duties, responsibilities and activities may change or be assigned at any time with or without notice.
Demonstration of UPH Values and Standards of Behaviors
Consistently demonstrates UnityPoint Health’s values in the performance of job duties and responsibilities
· Leverage the skills and abilities of each person to enable great teams
· Collaborate across departments, facilities, business units and regions
· Seek to understand and are open to diverse thoughts and perspectives
Own The Moment:
· Connect with each person treating them with courtesy, compassion, empathy, and respect
· Enthusiastically engage in our work
· Accountable for our individual actions and our team performance
· Responsible for solving problems regardless of the origin
· Commit to the best outcomes and highest quality
· Have a relentless focus on exceeding expectations
· Believe in sharing our results, learning from our mistakes, and celebrating our successes
· Embrace and promote innovation and transformation
· Create partnerships that improve care delivery in our communities
· Have the courage to challenge the status quo
Identify items that are minimally required to perform the essential functions of this position.
Preferred or Specialized
Not required to perform the essential functions of the position.
· High school diploma or equivalent
· One year of medical experience; preferably in community home health or pharmacy
· Registration with the Iowa Board of Pharmacy as a Certified Pharmacy Technician
· Valid driver’s license when driving any vehicle for work-related reasons
· Strong interpersonal skills
· Strong problem-solving skills with previous customer service experience
· Basic knowledge of computer applications (i.e. Word, Excel) and operations
Use of usual and customary equipment used to perform essential functions of the position.