Beth Israel Deaconess Medical Center Outpatient Pharmacy Authorization Specialist in Boston, Massachusetts
Outpatient Pharmacy Authorization Specialist
Job LocationBoston, Massachusetts
Req ID 16777BR
Department Description: The incumbent will be supporting the Outpatient Pharmacy Authorization areas across the BIDMC organization, inclusive of our off-site locations.
The anticipated schedule for this role is Monday through Friday, 8:30a.m.-5:00p.m.Job Location: Boston, MAReq ID: 16777BRJob Summary: Works with the Director of Referral Management to establish, implement and manage effective processes to ensure maximum reimbursement for outpatient and ambulatory pharmacologic or biologic products that are injected, infused or applied.
Manages and updates database of conditionally covered or non-covered ambulatory pharmacologic or biologic products that are payer specific. Communicates changes to appropriate stakeholder clinics throughout BIDMC.
Serves as a primary resource on payer specific ambulatory pharmacologic or biologic administration policies. Communicates changes in payer policies and prior authorization requirements to all medical center clinical areas, offsite health centers and related programs, physicians and other support services.
Educates patients (outpatient and inpatient when relevant) and providers about referral and prior authorization processes. Serves as liaison with payers to resolve coverage issues.
Research payer policies and coverage determinations proactively for new pharmaceuticals and technology information. Communicates approved FDA technologies and pharmaceuticals to appropriate departments affected.
Assists director with referring physicians in creating effective documentation for payer appeals and acts as liaison with fiscal and HIM to manage the appeal process. Creates and updates standard MD order templates with appropriate coding for outpatient departments and ambulatory clinics.
Bachelor's degree required. Master's degree preferred in Healthcare
3-5 years related work experience required.
Advanced skills with Microsoft applications which may include Outlook, Word, Excel, PowerPoint or Access and other web-based applications. May produce complex documents, perform analysis and maintain databases.
Experience with billing processes, prior authorizations, billing systems, ability to research complex issues.
Ability to compassionately interact with patients to to resolve complex payer coverage issues.
Written Communications: Ability to summarize and communicate in English moderately complex information in varied written formats to internal and external customers.
Oral Communications: Ability to comprehend and communicate complex verbal information in English to medical center staff, patients, families and external customers.
Knowledge: Ability to demonstrate in-depth knowledge of concepts, practices and policies with the ability to use them in complex varied situations.
Team Work: Ability to act as a team leader for small projects or work groups, creating a collaborative and respectful team environment and improving workflows. Results may impact the operations of one or more departments.
Customer Service: Ability to provide a high level of customer service and staff training to meet customer service standards and expectations for the assigned unit(s). Resolves service issues in the assigned unit(s) in a timely and respectful manner.
Physical Nature of the Job:
Sedentary work: Exerting up to 10 pounds of force occasionally in carrying, lifting, pushing, pulling objects. Sitting most of the time, with walking and standing required only occasionally