Are you looking for an opportunity to advance your pharmacy career? Our oncology team is expanding and is looking for an eager and detail - oriented coordinator to join our team! In this role, you will deal with complex prior authorization tasks for patients receiving oral chemo medications. This is great opportunity to expand your clinical and pharmacy knowledge.
Remote/Hybrid with occasional on-site requirements as needed for training, meetings, or departmental needs.Must live in MO or ILMon - Fri 8:00 AM - 4:30 PM
Preferred Experience
Oncology prior authorizationsSpecialty pharmacyFamiliar with payer portals and insurance benefits
Overview
BJC HealthCare is one of the largest nonprofit health care organizations in the United States, delivering services to residents primarily in the greater St. Louis, southern Illinois and southeast Missouri regions. With net revenues of $6.3 billion and more than 30,000 employees, BJC serves patients and their families in urban, suburban and rural communities through its 14 hospitals and multiple community health locations. Services include inpatient and outpatient care, primary care, community health and wellness, workplace health, home health, community mental health, rehabilitation, long-term care and hospice.
BJC is the largest provider of charity care, unreimbursed care and community benefits in the state of Missouri. BJC and its hospitals and health service organizations provide $785.9 million annually in community benefit. That includes $410.6 million in charity care and other financial assistance to patients to ensure medical care regardless of their ability to pay. In addition, BJC provides additional community benefits through commitments to research, emergency preparedness, regional health care safety net services, health literacy, community outreach and community health programs and regional economic development.
BJC’s patients have access to the latest advances in medical science and technology through a formal affiliation between Barnes-Jewish Hospital and St. Louis Children’s Hospital with the renowned Washington University School of Medicine, which consistently ranks among the top medical schools in the country.
Preferred Qualifications
Role Purpose
Works in coordination with other departmental and clinical staff to ensure coverage and reimbursement for specialty pharmacy services, including complex and/or high-dollar prior authorization support, copay assistance and patience assistance services. Responsible for completing all data elements in a timely and efficient manner and coordinating communication between clinical staff and patient to ensure prompt, and affordable, medication receipt.
Responsibilities
Expediting patient access to specialty medications by coordinating between provider offices, payors, and clinical edits to complete medication prior authorization utilizing medical record analysis and patient benefit investigation.Recording complete documentation of all authorizations within the patient record, including their expiration dates, appeal requirements or any necessary follow up.Complete confirmatory checks on existing pre-certifications, and insurance eligibility.Collaborate with case management department, third party payors, and manufacturer patient assistance programs to ensure patient receipt of medication when affordability or financial issues impact the patient.Supporting providers by assisting with prior authorization appeals. Advise patients on their specialty pharmacy network and identifying limited distribution alternatives.Minimum Requirements
Education
High School Diploma or GEDExperience