Pharmacy Insurance Clearance Specialist

• Participates in department staff meetings and keeps abreast of continuing education
• Data entry
• Pre-registers and registers patients using established procedures
• Ensures accurate entry of patient demographic and insurance information
• Manages incoming and outgoing calls to complete pre-registration with patients
• Communicates with physician and patients regarding status of authorization requests
• Ensures completion of all established policies and procedures for identification and notification of the Primary Care Physician
• Coordinates with patient and provider to ensure patient can select the most cost-effective options
• Maintains knowledge of all stand-alone computer software programs to verify eligibility
• Identifies and assists patients with access to internal and external financial assistance programs
• Initiates communication to the patient when authorization is not obtained
• Coordinates with patient, clinical team, and assistance programs to secure reimbursement or alternative coverage options
• Identifies at risk balances related to Medicaid eligibility rules
• Educates uninsured patients of financial responsibilities
• Refers patient for assessment of additional insurance coverage and internal charity programs
• Coordinates with patient and provider teams to complete applications for external program assistance
• Accurately collects and analyzes clinical data in support of reauthorizations for inpatient and outpatient services

• High School Graduate
• Typically requires 1 year of experience in health care, insurance industry, call center, or customer service setting
• Demonstrate ability to identify and understand issues and problems
• Ability to problem solve in a high profile and high stress area
• Mathematical aptitude, effective communication, and critical thinking skills
• Ability to prioritize and organize workload
• Excellent verbal and written communication skills
• Knowledge of medical terminology
• Demonstrated technical proficiency including experience with insurance authorization/eligibility tools, EPIC, Microsoft Office, Internet browser and telephony systems

Pharmacy Technician certification (CPhT) issued by the Pharmacy Technician Certification Board

• Paid Time Off programs
• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
• Flexible Spending Accounts for eligible health care and dependent care expenses
• Family benefits such as adoption assistance and paid parental leave
• Defined contribution retirement plans with employer match and other financial wellness programs
• Educational Assistance Program
• Opportunity for annual increases based on performance
• Premium pay such as shift, on call, and more
• Incentive pay for select positions