Accountable to obtain prior authorization for medications. Complete benefit investigation to determine coverage for prescribed treatment and act as a liaison for all medication prior authorization matters to insurance companies, Geisinger departments, and patients. Act as subject matter expert for patient medication assistance foundations, free drug and drug replacement programs for uninsured, under-insured, indigent population. Maintains updated knowledge of pharmacy reimbursement methodologies.
Completes prior authorization and documents referrals for all medications reviewed using appropriate third-party payer criteria.
Conducts research and follow-up activities within established timeframes. Maintains knowledge of criteria changes of third-party payor authorization requirements.
Establish and maintain communication with care team to provide details on authorization status.
Maintain current knowledge of all available patient assistance programs and eligibility requirements.
Identify available appropriate medication assistance programs upon discussing with patient the affordability of the prescribed treatment.
Ensures accurate completion necessary signatures of appropriate paperwork for enrollment in assistance program(s).
Track fund award end dates and exhaustion, and re-apply as necessary, to avoid lapse in therapies.
Establish and maintain communication with care team to provide details on status of assistance applications.
Educate providers and patients on CareSite Specialty Rx services and how this improves overall patient care. Grow the CareSite Specialty Rx's patient population.
Floats from areas of low workload to areas of heavy workload as needed to provide optional patient services.
Accountable for satisfying all job specific obligations and complying with all organization policies and procedures.
High School Diploma or Equivalent (GED)- (Required)
Minimum of 2 years-Related work experience (Required)
Certification(s) and License(s)
OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation. SAFETY: We provide a safe environment for our patients and members and the Geisinger family We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners. Perhaps just as important, from senior management on down, we encourage an atmosphere of collaboration, cooperation and collegiality. We know that a diverse workforce with unique experiences and backgrounds makes our team stronger. Our patients, members and community come from a wide variety of backgrounds, and it takes a diverse workforce to make better health easier for all. We are proud to be an affirmative action, equal opportunity employer and all qualified applicants will receive consideration for employment regardless to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or status as a protected veteran.
We are an Affirmative Action, Equal Opportunity Employer Women and Minorities are Encouraged to Apply. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of disability or their protected veteran status.
At Geisinger, our innovative ideas are inspired by the communities we serve – like our Fresh FoodFarmacy, a program that delivers life-saving healthy alternatives to patients with diabetes. With additional tools like our MyCode Community Health Initiative, one of the first health system genome sequencingprograms, and our new asthma app suite that we developed in partnership with AstraZeneca, it’s no wonder we’re ranked one of the Top 5 Most Innovative Healthcare Systems by Becker's Hospital Review. We continually work towards continuous improvement in a culture where everyone has a voice and firmly believe that better begins with all of us.Founded more than 100 years ago, Geisinger serves more than three million residents throughout central, south-central and northeastern Pennsylvania and southern New Jersey. Our physician-led system is comprised of 30,000 employees, including 1,600 employed physicians, and consists of 1...3 hospital campuses, the Geisinger Health Plan, Geisinger Commonwealth School of Medicine and two research centers. What you do at Geisinger shapes the future of health and improves lives – for our patients, communities, and you.