Patient Access Specialist - Specialty Pharmacy

Sanford Health hiring for Patient Access Specialist - Specialty Pharmacy jobs in Fargo, ND, US

Careers With Purpose

Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We're proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint.

Facility: Sanford Broadway Clinic

Location: Fargo, ND

Address: 737 Broadway N, Fargo, ND 58102, USA

Shift: 8 Hours - Day Shifts

Job Schedule: Full time

Weekly Hours: 40.00

Salary Range: 16.50 - 26.50

Department Details

Sanford Specialty Pharmacy is a fast growing department supporting patients across the full footprint of Sanford Health. Pharmacy operations are located in Fargo, ND. Our primary goal is to provide excellent customer service and help patients receive Specialty medications faster and maintain compliance on therapy.

Sanford Specialty Pharmacy is open Monday through Friday 8am-5pm, no weekends, no nights and closed on major holidays. Primary patient interactions are completed over the phone.

Sanford Specialty pharmacy is looking for a new team member who has great customer service, high attention to detail, adaptable to ever growing department needs, can multi-task with multiple systems, and ability to work well with pharmacy team staff and clinic staff.

In Specialty Pharmacy, pharmacy technicians will perform refill reminder calls, answer incoming phone calls from patients, complete data entry, fill prescriptions and ship medications under the direction of pharmacist.

Job Summary

The Patient Access Specialist reviews and validates insurance eligibility, submits required prior authorization of Specialty medications to insurance, and navigates copay assistance process. Expedites patient access to specialty medications by identifying and resolving barriers.

Collects necessary documentation and communicates with third party payers, healthcare professionals and customers to prioritize requests. Verifies patient registration and confirms benefit coverage, including deductibles and out-of-pocket expenses; researches and verifies covered benefits for ordered tests, procedures, and other services.

Responsible for assuring that prior authorization for medical services, including testing, procedures, surgery, Durable Medical Equipment (DME), and medications is completed and confirmed. Obtains diagnosis(es)/CPT code(s) from medical chart and/or provider office. Contacts third party payer to determine appropriate prior authorization process. Works closely with provider offices to obtain and clarify documentation to demonstrate medical necessity. If medical necessity criteria are not met, follows up with provider offices with guidance for Advanced Beneficiary Notices (ABN) or waivers that releases the financial burden of scheduled services from the facility to the patient. Reviews professional services denials; works with clinics and third party payers on appeal process.

Assures all required referrals are in place; may work on outgoing referrals for care outside Sanford Health. May have minimal telephonic patient interaction concerning provider referrals. May notify appropriate insurance companies when patients have checked in for inpatient services and procedures requiring observation periods. Documents work in case management module; provides direction to utilization management, case management, and nursing regarding what action needs to be taken. Collaborates with case management, social work, utilization management, and other cross-functional teams across the enterprise. Assists with the design and management of data including the preparation of reports and presentations.

Obtains copay assistance for patients to assist in affording of medications. Including obtaining copay cards from manufacturers, assisting patients through Grant process to obtain grant funding through National foundations, and assist patient and/or clinic in navigating Free Drug process with manufacturers. A critical role for Specialty Pharmacy in assuring patients are able to remain on life saving specialty medications.

Documents appropriately in EPIC all work flow processes established.

Educate patients on their insurance prescription benefits, advice on their specialty pharmacy network and identify limited distribution alternatives. Communicate expectations process and timing accurately to patients, caregivers and clinics. Communication occurs mainly over the phone and minimally in person.

Develop expertise in (at least) one specialty area to act as a subject matter expert for the team, clinics, etc.

Establish relationships with reimbursement managers and industry representatives to maintain current knowledge on available financial assistance programs.

Proactively work on prior authorizations that ae due to be expired.

Qualifications

High school diploma or equivalent preferred. Post-secondary education helpful.

Minimum of two years of experience in a hospital or clinic setting required. Understanding of medical terminology, insurance background, office equipment and computers is required.

Benefits

Sanford Health offers an attractive benefits package for qualifying full-time and part-time employees. Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, and a generous time off package to maintain a healthy home-work balance. For more information about Total Rewards, visit https://sanfordcareers.com/benefits .

Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-673-0854 or send an email to talent@sanfordhealth.org .

Sanford Health has a Drug Free Workplace Policy. An accepted offer will require a drug screen and pre-employment background screening as a condition of employment.

Req Number: R-0194631

Job Function: Revenue Cycle

Featured: No