Pharmacy Tech Certified (Retail)- 40hrs/wk day/evening
Company: Steward Health Care
Location: Brighton
Posted on: April 24, 2024
Job Description:
Location: St. Elizabeth's Medical Center Posted Date: 12/18/2023
Job Type: See job requirements for other schedule information
Department: 0101.56190 SEH SEHC Pharmacy Pharmacy Tech (Retail) -
full-time 40hrs/wk, dayevening shift, 11a-7:30p/12:30p-9pm Mon-Fri,
weekends required as needed. We are fighting for a healthier world
and a new era of wellness! Over a decade ago, we set out to build
an entirely different kind of health care company from the ground
up-one that unlocks access to affordable, high-quality, and
economically sustainable care and wellness in ways never imagined.
Today, we are one of the largest private, physician-led health care
networks-caring for millions of people across the U.S. Our
transformative, fully integrated model represents a new beginning
for America's health care system and others around the world. We
have hospitals across 7 states serving over 800 communities, with
more than 43,000 employees. We are ushering in a new day of world
class health care. From renowned pediatricians, sports medicine
specialists and cardiac surgeons to state-of-the-art hospitals,
urgent care centers and medical practices, we can offer easier
access to high-quality affordable health care to people nationwide
- when they need it and where they want it. St. Elizabeth's Medical
Center, a Boston University Teaching Hospital, provides patients
and families access to some of Boston's most respected physicians
and advanced treatments offering specialized care, including:
- Advanced Center for Cardiac Surgery
- da Vinci - Robotic surgery program; Mako Robotic-Arm Assisted
Surgery
- Level III Neonatal Intensive Care Unit (NICU)
- Award-winning bariatric surgery program
- Dana-Farber Cancer Institute at St. Elizabeth's Medical
Center
- State-of-the-art emergency care with short wait times Our
medical staff, made up of some of the highest rated physicians in
Boston, treats patients in our community practices in
neighborhoods, including Allston, Boston, Brighton, Brookline,
Newton, Watertown and Weston. Benefits:
- Grow with a health system that supports career advancement
- Competitive Pay & Salary Increases
- Employee Referral Program
- Locations close to home, that support work-life balance
- Affordable Medical, Dental and Vision Coverage
- 401k via Fidelity, for eligible employees, with company
match
- Tuition Assistance / Reimbursement
- Family atmosphere and team approach that provides
flexibility
- Opportunities to grow your career, and not change your
employer
- And much more! Job Summary - Under the supervision of the
Director of Pharmacy in conjunction with the Manager of
Clinical-Specialty Pharmacy, is responsible for setting up cases in
various applications for drug prior authorization (PA) requests and
performs daily quality checks to ensure compliance. Within this
role, this person will provide patient care by removing the
barriers to medication access. Will work closely with Point 32
Health, which manages PA coding with our Pharmacy Benefit Manger
for US Family Health Plan (USFHP) insurance. Will process the
formulary changes from the Tricare Beneficiary Advisory Panel
minutes for USFHP members and coordinate medication coding updates
in conjunction with Point 32 Health to ensure proper formulary drug
coding through our PBM. Will be the liaison with clinician offices
to facilitate approval of medications through prior authorizations.
The coordinator will run claims once authorization is approved and
reach out to members and providers as necessary. This role will
oversee the daily operations for prior authorization management
activities designed to achieve quality and service driven
objectives. Educates and directs Pharmacist and Pharmacy
Technicians for all related processes in this workflow.
Qualifications Minimum Education/Experience:-- -
High School Diploma or equivalent
required. Must have at least 3 years' experience with pharmacy and
medical prior authorization processes and electronic health
records. In addition, must have at least 3 years' experience
working with insurance formularies and coding with pharmacy benefit
managers. Minimum skills/abilities:
- Knowledge of CPT and ICD coding highly desired
- Knowledge of third-party payer regulations and guidelines
highly desired
- Proficiency in PC software, especially Microsoft Word and Excel
spreadsheet programs
- Experience with electronic health record systems
- Ability to effectively manage multiple demands, working under
moderate to high degree of pressure
- Ability to multi-task and problem solve with strong
organizational skills.
- Excellent leadership skills and strong decision making and
self-motivation skills.
- Strong organizational, prioritization, communication, and
mathematical skills.
- Knowledge of Specialty Pharmacy Operations and third-party
payers and insurance plans.
- Ability to understand the importance of and respect the
confidentiality of all patient information. Certification/Licensure
- BS in Pharmacy or CPhT with an active and in good standing
licensure with the MA State Board of Pharmacy. Must meet all
requirements for annual Continuing Education Credits. Job
Responsibilities
- Manage and process formulary drug coding updates in conjunction
with Point 32 Health.
- Manages and optimizes workflows to achieve successful
operational and quality outcomes and benefit maximization within
the scope of responsibilities.
- Maintain a current knowledge base related to insurance
formulary requirements for prior authorization. Serve as primary
resource on prior authorization requirements
- Directly communicate with Point 32 Health to facilitate the
approval of medications in a timely manner through the Pharmacy
Benefit Manager, Optum RX.
- Review prescriptions with provider offices to ensure optimal
care of the patient.
- Navigate pharmacy operation systems to input data, perform
adjudication and prepare action plans for follow-up.
- Able to accurately complete data entry of all new incoming
prescriptions for specialty drugs and drugs requiring prior
authorizations. This includes calling prescribers to clarify any
issues with the dosing and directions.
- Filling out and sending the correct prior authorization forms
to the prescriber and ensuring we have the correct contact
information for their office, to complete the prior authorization
process without delay.
- Knowing the formulary of the insurance plan to ensure we are
using the most cost-effective options for both the plan and the
patients.
- Provide the prescriber with all the information needed to
complete the prior authorization and if applicable give them the
insurance preferred alternatives.
- Requesting clinical notes and lab work when necessary, in
addition to the prior authorization forms to ensure the medication
prescribed is clinically appropriate and the Clinical-Specialty
pharmacist has all the necessary information.
- Under the supervision of our Clinical-Specialty Team, ensure
timely follow-up and processing all prior authorizations for USFHP
approving appropriate therapies and denying inappropriate or
non-formulary therapies.
- Contacting prescribers when a non-preferred biosimilar drug is
prescribed and if appropriate, having it changed to the
preferred.
- Call patients regarding dose changes, insurance rejections and
coverage issues, copay changes and deductibles for all PA and
specialty medications.
- Make arrangements with pharmacy staff to facilitate the
appropriate packaging of specialty medications to ensure the
contents remain at the proper and stable temperature during the
shipping process.
- Communicate with the post office regarding any issues with
lost, delayed, or missing packages to determine if the patient will
need an emergency supply sent or a replacement package.
- Communicate requirements for our PA and Specialty Programs to
patients and providers
- Be the liaison between provider offices and patients to request
new prescriptions for specialty medications to ensure the patient
does not miss a dose.
- Facilitate PA approvals to insurances for proper coding to
ensure the prescription claim is set up to clear for adjudication
with the appropriate co-pay. Facilitate communications to patients,
provider offices and infusion centers to assure proper and timely
delivery of specialty medications.
- Identifying coding/copay errors based on the plan formulary so
they can be corrected.
- Communicating with the medical side of the insurance to process
prior authorizations needed on the medical side for which we are
responsible to provide the medication to the office.
- Planning the workflow for the PA and Specialty processes which
may include enlisting and deploying staff to ensure timely
processing.
- Responsible for knowing when generic medications first become
available and their costs from our distributer compared to the
brand name so we can adjust insurance coding accordingly.
- Ordering Specialty Medications when needed and assuring the
proper storage of them.
- Scheduling the delivery of specialty medications to patients
directly and to doctor offices or infusion centers.
- Onboarding new members of the USFHP insurance plan to introduce
them to our pharmacy and make certain that they are aware of how
the home delivery service works. Since home delivery is the most
cost-effective way to provide medications to our members, this
individual will obtain all maintenance medications for these
members from their providers and set them up for processing.
- As part of our cost-saving initiatives, this individual will be
responsible for working with weekly Excel files to transfer
maintenance medications from retail pharmacy locations to be filled
by our Home Delivery Service. This is also beneficial to USFHP
members as they will pay less in co-pays and get up to a 90-day
supply of medication instead of 30 at retail by utilization that
service.
- Assisting the Clinical-Specialty Pharmacy Team by reaching out
to patients to increase adherence to maintenance medications.
- Demonstrate and apply knowledge of medical terminology, high
proficiency of general medical office procedures including HIPAA
regulations. Steward Health Care is an Equal Employment Opportunity
(EEO) employer. Steward Health Care does not discriminate on the
grounds of race, color, religion, sex, national origin, age,
disability, veteran status, sexual orientation, gender identity
and/or expression or any other non-job-related characteristic.
About Steward Health Care
Over a decade ago, Steward Health Care System emerged as a
different kind of health care company designed to usher in a new
era of wellness. One that provides our patients better, more
proactive care at a sustainable cost, our providers unrivaled
coordination of care, and our communities greater prosperity and
stability.
As the country's largest physician-led, minority-owned, integrated
health care system, our doctors can be certain that we share their
interests and those of their patients. Together we are on a mission
to revolutionize the way health care is delivered - creating
healthier lives, thriving communities and a better world.
Based in Dallas, Steward currently operates more than 30 hospitals
across Arizona, Arkansas, Florida, Louisiana, Massachusetts, Ohio,
Pennsylvania, and Texas.
For more information, visit steward.org
Keywords: Steward Health Care, Boston , Pharmacy Tech Certified (Retail)- 40hrs/wk day/evening, Healthcare , Brighton, Massachusetts
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