Reimbursement Specialist

University Health System- San Antonio; San Antonio (TX); On-site; USD 36,000 - 48,000; Full time

Job summary

University Health System- San Antonio is seeking a Pharmacy Technician to enroll indigent and under-insured patients into drug assistance programs and to manage ongoing eligibility and shipments.

The role requires a Texas State Board of Pharmacy registration and a recommended CPhT certification, with at least three years in medical/pharmacology settings, including project coordination and data management.

Qualifications

• Texas State Board of Pharmacy registration required.
• CPhT certification recommended.
• Three years experience in a medical/pharmacology field including project coordination; database/spreadsheet development and management; and/or application programming; processing and overseeing medical insurance billing and reimbursement cost capture.
• Must have demonstrated independent judgment.

Responsibilities

• Identify and enroll indigent and under-insured patients into drug assistance programs.
• Monitor continued eligibility status and document shipments in a computerized tracking system.
• Facilitate resolution of insurance denial referrals with pharmacy, hospital administration, medical staff and patient assistance programs.
• Coordinate information for patients enrolled in assistance programs using various software.
• Create and maintain computerized databases to support enrollment and track case-specific assistance.
• Conduct patient interviews and discuss denial potential with patients and medical staff.
• Review outpatient third-party rejections and assist patients in resolving the problem.
• Coordinate third-party billing, eligibility issues, with the Outpatient Pharmacy Supervisor and the Pharmacy Billing Section.

Skills

Independent judgment

Project coordination

Data entry / database skills

Communication skills

Insurance billing knowledge

Education

Texas State Board of Pharmacy registration

Certified Pharmacy Technician (CPhT) recommended

Tools

Database management

Spreadsheet development

Job description

POSITION SUMMARY/RESPONSIBILITIES

Identifies and enrolls indigent and under-insured patients into drug assistance reimbursement programs which provide drug replacement and reimbursement compensation. Monitors continued eligibility status and documents drug shipments received in computerized tracking system. Serves as a resource in facilitating resolution of insurance denial referrals. Communicates effectively with pharmacy, hospital administration, medical staff, patients and personnel in the patient assistance programs using verbal and written interpersonal communication skills. Requires ability to work independently and coordinate assigned projects efficiently. Effectively utilizes problem-solving ability, significant interpersonal contact and concentration abilities, analytical skills and in depth knowledge of computer software. Coordinates all information regarding patients enrolled in assistance programs for drug therapies using various computer software programs. Creates, expand and maintains computerized databases to support patient enrollment in assistance programs and tracks case specific assistance provided in response to reimbursement denials. Conducts patient interviews and conveys reimbursement denial potential to patient and medical staff. Reviews all outpatient 3rd party rejections and assists the patient in resolving the problem. Coordinates 3rd party billing, problems with eligibility, rejections, etc. with the Outpatient Pharmacy Supervisor and the Pharmacy Billing Section.

EDUCATION/EXPERIENCE

Texas State Board of Pharmacy registration required. National Certification as a Certified Pharmacy Technician (CPhT) is recommended. Three years experience in a medical or pharmacology related field to include project coordination; database/spreadsheet development and management; and/or application programming; processing and overseeing medical insurance billing and reimbursement cost capture. Must have demonstrated independent judgment.