Insurance Retention Agent Jobs in Fall River, MA

SUMMARY:Reports to Manager, Medication Access Program (MAP). Under the supervision of a pharmacist and direction of a Pharmacy Technician Supervisor or Technician Group Leader, the Ambulatory Liaison, utilizes established MAP processes to facilitate affordable, accessible, and reliable pharmacy services for patients. Interacts effectively and compassionately with patients and families.Acts as an agent of the provider to authorize refills in accordance with established practices, policies, and guidelines. Interacts effectively and professionally with other health care providers at all levels including, but not limited to, providers, nurses, and support personnel. Utilizes the patient’s electronic health record (EHR) to obtain accurate and necessary patient information needed to process prescriptions and payment transactions. Accesses, inputs, and retrieves information using multiple pharmacy system applications.Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another.In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done. The core Success Factors include:Instill Trust and Value DifferencesPatient and Community Focus and CollaborateRESPONSIBILITIES:Exhibits a friendly, pleasant, and helpful nature demonstrating a strong customer service orientation when interacting with patients, their families, providers, nurses, and support personnel. Maintains and supports pharmacy interdepartmental relationships to ensure seamless transition of patient care from clinic to pharmacy.Protects and maintains patient confidentiality in accordance with Health Insurance Portability and Accountability Act (HIPAA) guidelines. Collects customer/patient personal information necessary for filling prescriptions, benefits investigation, prior authorization, and/or financial assistance applications. Enters pertinent patient data into appropriate organizational systems to ensure accurate charging for services and processing of insurance billing, payments, and co-pay information.Participates in the growth of the Brown University Health Pharmacy (LP) patient population through recruitment of ambulatory care patients. Responds to questions relative to cost and availability of medication and pharmaceutical supplies. Informs customers/patients, providers, and support personnel of wait times and any issues regarding drug availability, including advising on the refill authorization process for expired prescription orders.Encourages patient retention through the development of individual relationships with assigned patients. Proactively contacts patients via phone, in-person, or other supervisor approved modality to assess patient need for medication, including estimations of patient adherence such as medication supply on hand. Assists patients/customers in resolving identified problems. Proactively identifies patients with clinical needs such as questions concerning medications and drug interactions and refers such patients to a pharmacist.Participates in quality assessment and improvement activities. Assists in identifying improvement opportunities and in the development of new processes. Participates in medication safety initiatives related to LP and uses approved processes for reporting actual, prevented and near miss medication errors.Under the guidance of a pharmacist and direction of a Technician Supervisor or Group Leader assists in training, onboarding, and supporting fellow staff.iPrior Authorization and Financial Assistance Services:iConducts a benefits investigation for patients, identifies coverage details that the patient or patient’s representative is unable to provide. Navigates the EHR to effectively answer questions and provide documentation as needed for prior authorizations and/or financial assistance application. Performs prior authorizations, appeals, and tier exceptions as necessary, on provider’s behalf, and relays results to patients, families, providers, and pharmacies as appropriate.Secures treatment related financial assistance for patients whenever possible including, but not limited to, manufacturer assistance programs, discount programs, and nationally recognized foundations. Refers patients to medication manufacturer assistance programs and assists with application to said programs, when applicable. Coordinates submission of financial assistance application between patient, clinic, and providers to ensure all paperwork is submitted appropriately for qualifying patients.iPrescription Refill Services as an Agent of a Providerii:iiiActing as the agent of a provider, who is a licensed clinician, employed, or under contract with a Brown University Health affiliated entity and has agreed in writing to participate (Opt-in) in the Brown University Health Medication Access Program (MAP), hereinafter referred to asiProvideri, the Ambulatory Liaison authorizes prescription refills in accordance with the document entitled “Brown University Health Medication Access Refill Guideline”.iiActing as the agent of a Provider communicates to Provider’s patients or their pharmacy the Provider’s approval of refills permitted under the Brown University Health MAP.Using the MAP and the conditions set forth in the “Brown University Health Medication Access Refill Standards” approves prescription refills under certain conditions while requiring further consultation with the prescribing clinician or the assistance of the pharmacist for other requested refills.Consults the EHR, MAP, and Brown University Health Medication Access Refill Standards prior to authorizing any refill requests.Confirms that the patient’s Provider has signed a MAP Prescriber Brown University Health Medication Access Refill - Prescriber Opt-in form, giving Ambulatory Liaison’s approval, in advance, to authorize prescription refills.Approves the prescription refill request if the patient has seen the provider within the specified amount of time, laboratory testing is up to date, and requested medication is on both the medication list in the EHR and the Brown University Health Medication Access Refill Standards.Reroutes requests to provider, clinical staff, office staff, or pharmacist when defined criteria in “Brown University Health Medication Access Refill Standards” are not met.Refuses refill requests as per the “Brown University Health Medication Access Refill Guidelines”.Assists providers in identifying ancillary supplies necessary for select medications including, but not limited to, sharps containers, needles/syringes, alcohol swabs, and bandages.MINIMUM QUALIFICATIONS:BASIC KNOWLEDGE:iPrior Authorization and Financial Assistance Servicesii:iiiHigh school graduate or equivalent degree required. Completion of one to two years of college preferred.Maintains current unrestricted Rhode Island Pharmacy Technician II license.Holds and maintains current National Pharmacy Technician Certification (CPhT).iPrescription Refill Services as an agent of a Providerii:iiiHigh school graduate or equivalent degree required. Completion of one to two years of college preferred.Holds and maintains current National Pharmacy Technician Certification (CPhT).EXPERIENCE:Minimum one year experience as a pharmacy technician. Commensurate experience in a related field (e.g., benefits management) may be considered in lieu of technician experience. Prior experience with specialty pharmacy services, call center customer service, prior authorization management, and/or patient financial assistance programs strongly preferred.Strong customer service presence and verbal and written communication skills necessary to effectively interact with patients, providers, nurses, and ancillary support staff required.Solid computer skills including Microsoft Office Suite, web applications, and multiple pharmacy system applications.Ability to multi-task and reprioritize as needed while maintaining accuracy and service standards.Must obtain within 3 months of hire, and maintain no less than annually thereafter, pharmacy ambulatory liaison competency requirements as demonstrated through completion of the Medication Access Program Competency Checklist, as well as disease state-specific training, accreditation updates, and other operational competencies as required.WORK ENVIRONMENT AND PHYSICAL REQUIREMENTS:Extended periods of time spent sitting.Work requires the visual acuity and manual dexterity necessary to operate a computer and input data using a typical keyboard and computer mouse to navigate multiple computer monitors.INDEPENDENT ACTION:Performs independently within department policies and procedures.Refers specific complex problems to supervisor where clarification of departmental policies and procedures may be required.SUPERVISORY RESPONSIBILITY:None.

Pay Range:

$20.96-$34.61

EEO Statement:

Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment.

Location:

The Miriam Hospital - 164 Summit Ave Providence, Rhode Island 02906

Work Type:

Monday-Friday 8 hour shift between 7am to 6pm

Work Shift:

Day

Daily Hours:

8 hours

Driving Required:

No