Specialty Pharmacy Liaison
Department Description: BIDMC Specialty Pharmacy
Job Location: Boston, MA
Req ID: 30934BR
Job Summary: This position acts as a liaison between the specialty/retail pharmacy and the prescribers to document, submit, communicate outcomes and appeal if necessary all pharmacy/medical prior authorizations. Is also involved in all aspects of obtaining patient access to prescribed medication.
- Understands product and payer reimbursement landscape and prior authorization guidelines and processes.
- Collects and reviews all data needed pharmacy and/or medical for prior authorization approvals.
- Resolves insurance related issues, including prior authorizations (PAs), and assist patients with various forms of financial assistance.
- Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly; maintains frequent phone contact with patient, provider and pharmacy staff; and clarifies prescription orders with pharmacist and/or clinician as appropriate.
- Serves as the direct patient and provider contact for pharmacy benefit information, clinical and program information.
- High School diploma or GED required.
- License Mass Registered Pharmacy Tech required.
- 3-5 years related work experience required in Pharmacy.
- Experience with computer systems required, including web based applications and some Microsoft Office applications which may include Outlook, Word, Excel, PowerPoint or Access.
- PTCB certification
- Specialty Pharmacy experience and/or prior authorization experience.
- Knowledge of medication use in RA, GI, transplant, hepatitis C, infectious disease (including HIV), and/or oncology a plus.
- Decision Making: Ability to make decisions that are guided by general instructions and practices requiring some interpretation. May make recommendations for solving problems of moderate complexity and importance.
- Problem Solving: Ability to address problems that are varied, requiring analysis or interpretation of the situation using direct observation, knowledge and skills based on general precedents.
- Independence of Action: Ability to follow precedents and procedures. May set priorities and organize work within general guidelines. Seeks assistance when confronted with difficult and/or unpredictable situations. Work progress is monitored by supervisor/manager.
- Written Communications: Ability to communicate clearly and effectively in written English with internal and external customers.
- Oral Communications: Ability to comprehend and communicate complex verbal information in English to medical center staff, patients, families and external customers.
- Knowledge: Ability to demonstrate full working knowledge of standard concepts, practices, procedures and policies with the ability to use them in varied situations.
- Team Work: Ability to act as a team leader for small projects or work groups, creating a collaborative and respectful team environment and improving workflows. Results may impact the operations of one or more departments.
- Customer Service: Ability to provide a high level of customer service to patients, visitors, staff and external customers in a professional, service-oriented, respectful manner using skills in active listening and problem solving. Ability to remain calm in stressful situations.
Physical Nature of the Job:
Sedentary work: Exerting up to 10 pounds of force occasionally in carrying, lifting, pushing, pulling objects. Sitting most of the time, with walking and standing required only occasionally