Primary City/State:
Phoenix, Arizona
Department Name:
Patient Advisory
Work Shift:
Day
Job Category:
Pharmacy
UP TO A $5,000 SIGN ON BONUS AVAILABLE
Pharmacy careers are better at Banner Health. We are committed to developing the careers of our team members. We care about you, your career today and your future. If you're looking to leverage your abilities - apply today.
Banner Health was recognized on Becker's Healthcare 2024 list of 150+ top places to work in healthcare. This list highlights hospitals, health systems and healthcare companies that prioritize workplace excellence and the happiness, satisfaction, wellbeing and fulfilment of their employees.
Phoenix is Arizona's major city and the fifth most populated city in the United States. It includes the posh resorts and green golf courses of Scottsdale, Tempe's lively college-town vibes, arts-friendly Mesa and pro-sports hub Glendale, several American Indian tribal lands, and the suburban cities of Chandler and Gilbert.
As a Pharmacy Patient Advocate, you will work onsite to support the Banner Rheumatology clinic at 1441 N 12th St in Phoenix. This role requires knowledge of prior authorization process submitted through medical benefit, medical nomenclature, and the metric system. This position also requires consistent follow up with insurance companies to ensure supporting documents have been received, provide clarification for additional information needed for determination, and if needed, coordinate peer to peer or appeal. You will use programs such as; Cerner Pool messaging, Third party insurance portals, and Adobe Pro. Your schedule is Monday through Friday, 8AM - 4:30PM, excluding holidays.
Recruiter to provide sign-on eligibility during the interview process. Your pay and benefits are important components of your journey at Banner Health. This opportunity includes the option to participate in a variety of health, financial, and security benefits.
Banner Pharmacy Services is a recognized leader in healthcare and trusted partner in proactively providing innovative pharmacy services through excellence in integration, care coordination, medication management and services to make a difference in people's lives. Clinical Pharmacy Services is responsible for the management of the Banner formulary, development of standardized system wide clinical pharmacy services, and management of adverse drug event preventions. Clinical Pharmacy Services provides collaborative drug therapy management and educational interventions in patient care to optimize medication therapy, improve outcomes, promote wellness, and disease prevention. As a division, Banner Pharmacy services provides excellent patient care across our entire continuum through convenient access, improved medication outcomes and innovative pharmacy practices.
POSITION SUMMARY
This position will work under the supervision of the pharmacist and/or technician supervisor. Requires knowledge of drugs, medical nomenclature, and the metric system to enter data into the computer system to fill prescriptions and to obtain reimbursement/payment. Serves as a liaison between the customer and the pharmacists, physicians, and third party administrators. Will also take requests for prescription refills and obtain necessary prior authorizations. Available, as scheduled, to answer inbound calls while protecting the confidentiality of member information and adhering to company policies regarding patient health information (PHI). Makes outbound calls as needed, faxes providers' offices, and provides exceptional, courteous and professional customer service. Must demonstrate the ability to research complex issues across multiple databases, work with support resources to resolve member issues, and own problems through to resolution on behalf of the member in real time or follow-up with the member as soon as possible.
CORE FUNCTIONS
Researches clinical data necessary to complete and maintain prior authorization, and interfaces with prescribers to ensure that referrals are complete and include all necessary clinical and demographic information. However, PPAs are prohibited from conducting evaluation or interpretation of clinical data.
Performs test claims to determine copayment/coinsurance amounts, with applicable patient assistance programs. Understand copays, formularies and special pricing to ensure claims are adjudicated correctly and adjustments are performed when applicable.
Builds and maintains strong relationships with patients, and serves a primary point-of-contact throughout the duration of therapy. Educates the patient about coordination of benefits and plan of care.
Obtains applicable financial resources, such as patient assistance and foundation grant support, to assist in covering the patient's portion of therapy. Interfaces with revenue cycle to establish payment plans, when necessary, and coordinates communication with the patient regarding patient financial responsibility.
Documents coordination of benefits and plans of care in pharmacy applications, and communicates to stakeholders as needed to ensure optimal medication therapy. Partner with others to handle and resolve escalated issues when appropriate and act urgently when necessary.
Input orders efficiently with attention to detail, includes order entry, billing, crediting, and updating medical records. Meet departmental standards for production and quality improvement strategies, schedule adherence as well as participate in training and self-development opportunities when appropriate.
Attends to customers and answers telephones in a courteous and timely manner. Serves as a liaison between the customer the pharmacists, physicians, and third party members. May also take requests for prescription refills and obtain necessary prior authorizations.
Works with various parties such as third party payers, providers, and other pharmacies while providing proper documentation for adjudication discrepancies or to obtain prior authorizations when needed.
This position services patients referred to an outpatient pharmacy service line, but has no role in the clinical aspects of the patient management program. Internal customers include but are not limited to employees, patients, and management at the local, regional, and corporate levels. External customers include but are not limited to, practicing physicians, vendors, and the community.
MINIMUM QUALIFICATIONS
Skills and knowledge typically attained with acquiring a Pharmacy Technician License. Current and unrestricted licensure is required.
Incumbents in Arizona are also required to provide the AZ Board of Pharmacy Wallet Card at time of hire.
May be required to possess a valid driver's license.
Must demonstrate 3 or more years of experience performing in a pharmacy technician role. Must possess good organizational, problem solving, and computer skills. Must have good written and verbal communication skills for interfacing with all levels of staff, physicians, patients and other contacts. Previous experiences working with pharmacy benefit managers, insurance verification, or patient assistance.
Previous experiences working with pharmacy benefit managers, insurance verification, or patient assistance. Employees working at Banner MD Anderson on the Banner University Medical Center Phoenix campus must possess a State of Arizona Department of Public Safety Level One Fingerprint Clearance Card at the time of hire and maintain the card for the duration of their employment. This is a requirement of the Whole Family Counseling Program held at this specific facility.
PREFERRED QUALIFICATIONS
Pharmacy Technician Certification Board (PTCB) certification. Pharmacy technician experience. Knowledge of medication management information system software and automated dispensing systems. Highly proficient in analyzing complex claim transactions and systems with the ability to effectively define issues, collect data, establish facts, and draw valid conclusions. Ability to follow changing instructions and execute special projects as required and additional duties as assigned.
Additional related education and/or experience preferred.
EEO Statement:
EEO/Female/Minority/Disability/Veterans (https://www.bannerhealth.com/careers/eeo)
Our organization supports a drug-free work environment.
Privacy Policy:
Privacy Policy (https://www.bannerhealth.com/about/legal-notices/privacy)
EOE/Female/Minority/Disability/Veterans
Banner Health supports a drug-free work environment.
Banner Health complies with applicable federal and state laws and does not discriminate based on race, color, national origin, religion, sex, sexual orientation, gender identity or expression, age, or disability
