Patient Financial Counselor - Pharmacy

Michigan Medicine; Ann Arbor (MI); Hybrid; USD 42,000 - 65,000; Full time

Benefits offered by this job

Excellent medical coverage

Retirement savings match

Job summary

Michigan Medicine is seeking a Patient Financial Counselor for HomeMed Pharmacy Services to coordinate medication access and financial information for patients. You will verify demographics, insurance, and required documentation for home infusion referrals, and support the reimbursement intake team with authorizations and necessary medical documentation.

Responsibilities include handling inquiries, assisting patients with access to manufacturers and extended coverage options, and contributing to

Qualifications

• 3+ years of prior authorization experience through pharmacy and/or medical benefits.
• Strong knowledge of medical and/or prescription insurance requirements and ability to explain benefits clearly to diverse audiences.
• Proven record of delivering excellent customer service.

Responsibilities

• Complete referral processing and documentation per procedures.
• Provide patient account information and answer inquiries.
• Review accounts and determine action to collect payments.
• Make outbound calls to insurers and patients to verify benefits.
• Meet productivity goals through timely documentation and referrals.

Skills

Prior authorization

Insurance knowledge

Customer service

Communication

Time management

Education

Healthcare degree

Tools

Epic

Billing software

Job description

Mission Statement

Michigan Medicine improves the health of patients, populations and communities through excellence in education, patient care, community service, research and technology development, and through leadership activities in Michigan, nationally and internationally. Our mission is guided by our Strategic Principles and has three critical components; patient care, education and research that together enhance our contribution to society.

Job Summary

The Patient Financial Counselor (PFC) will coordinate medication access and financial information and assistance to HomeMed patients. Characteristic duties include; obtain and verify patient demographic, clinical and insurance information as required prior to initiating home infusion services and contribute to completing the workload (e.g., prior authorizations, medical need documentation) of the home infusion referral/reimbursement intake team. Additionally, performs critical and complex intake-related functions requiring analysis, evaluation and an in-depth understanding of reimbursement pathways, reviews and verifies insurance accounts against program provisions (e.g., Medicare, Blue Cross).

Responsibilities

• Completes referral processing and documentation functions based on existing practices and procedures.
• Provides patient account information and answers customer inquiries.
• Reviews patient accounts and determines appropriate action needed to collect payment.
• Makes outbound calls to insurance companies and patients to verify insurance benefits.
• Achieves productivity goals based on obtaining timely documentation and processing of referrals.
• Thoroughly reviews new patient services on a regular basis, and provides the necessary documentation (e.g., Prior Authorizations, Certificates of Medical Necessity) to ensure timely reimbursement.
• Assist eligible patients in navigating access to manufacturers and extended coverage options.
• Adapts procedures, processes and techniques to accomplish the goals of the organization.
• Serves as a resource to others in the resolution of complex problems and issues.
• Train new and existing staff regarding applicable department policies and practices.
• Applies advanced skills in performance of critical and complex patient referral-related functions
• Assists billing staff with resolution of complex billing issues and conducts problem-solving in a professional manner
• Takes initiative to independently resolve a variety of complex issues and develop and implement quality improvement initiatives when necessary

Position reports directly to

HomeMed Pharmacy Services Manager - Reimbursement

Work Environment

• General office environment with open and closed workspace; computer, telephone, Microsoft application & other software inputs.

Required Qualifications

• Graduation from high school or equivalent of education and experience.
• 3 or more years of prior authorization experience through pharmacy and/or medical benefits
• Strong knowledge of medical and/or prescription insurance requirements, with the ability to accurately interpret and confidently explain insurance benefits and coverage details to diverse audiences
• Proven record of providing excellent customer service

Desired Qualifications

• Associate or bachelor's degree in a healthcare related field
• Skilled in the use of Microsoft Word and Excel
• Experience with Epic and/or other billing and pharmacy dispensing software

Skills & Abilities

• Highly skilled in oral and written communication for content, clarity, and delivery
• Ability to manage multiple tasks simultaneously while meeting strict deadlines
• Ability to work in a fast-paced environment, consistently problem solving and managing time in an efficient and productive manner
• Ability to work well as a team with minimal supervision
• Ability to manage time-sensitive information while maintaining strict patient confidentiality

Why Join Michigan Medicine?

Michigan Medicine is one of the largest health care complexes in the world and has been the site of many groundbreaking medical and technological advancements since the opening of the U-M Medical School in 1850. Michigan Medicine is comprised of over 30,000 employees and our vision is to attract, inspire, and develop outstanding people in medicine, sciences, and healthcare to become one of the world's most distinguished academic health systems. In some way, great or small, every person here helps to advance this world-class institution. Work at Michigan Medicine and become a victor for the greater good.

What Benefits can you Look Forward to?

• Excellent medical, dental and vision coverage effective on your very first day
• 2:1 Match on retirement savings

Modes of Work

Positions that are eligible for hybrid or mobile/remote work mode are at the discretion of the hiring department. Work agreements are reviewed annually at a minimum and are subject to change at any time, and for any reason, throughout the course of employment. Learn more about the work modes.

Union Affiliation

This position is covered under the collective bargaining agreement between the U-M and the Service Employees International Union (SEIU), which contains and settles all matters with respect to wages, benefits, hours, and other terms and conditions of employment.

Background Screening

Michigan Medicine conducts background screening and pre-employment drug testing on job candidates upon acceptance of a contingent job offer and may use a third party administrator to conduct background screenings. Background screenings are performed in compliance with the Fair Credit Report Act. Pre-employment drug testing applies to all selected candidates, including new or additional faculty and staff appointments, as well as transfers from other U-M campuses.

Application Deadline

Job openings are posted for a minimum of seven calendar days. The review and selection process may begin as early as the eighth day after posting. This opening may be removed from posting boards and filled anytime after the minimum posting period has ended.

U-M EEO Statement

The University of Michigan is an Equal Opportunity Employer. We are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants, including protected veterans and individuals with disabilities.