Description

The Prescription Refill Specialist is a member of the primary care team that provides patient care and provider support by preparing prescription refills, resolving pharmacy errors, and submitting medication prior authorizations to health benefit plans. Provides timely and quality customer service over the phone to patients, pharmacies, and insurance companies.

Prescription Refill Coordination

Complete refill requests for the Mosaic Medical system using established procedures.

Transmit or re-transmit prescription information to pharmacy.

Act as liaison between patient and pharmacy to resolve refill errors, billing discrepancies, and supply shortages.

Review medication fill histories for patient compliance or divergence.

Review patient eligibility for medication assistance and route to appropriate teams.

Act as liaison between Assisted Living Facilities, other provider offices, and insurance plans to determine appropriate medication usage.

Review patient medication and supply requests and route to the appropriate staff/care team.

Maintain active communication with Providers and Pharmacy Staff to ensure patients can receive medications.

Educate and inform staff of medication refill processes.

Prior Authorization Coordination

Process medication prior authorizations and appeals in a timely and efficient manner through coordination of insurance, primary care provider and patient requests.

Expedites the administrative requirements for patient prior authorizations, dealing directly with health plans.

Verifies insurance coverage and obtains authorizations if needed from insurance.

Able to distinguish between medical medication insurance claims and pharmacy medication insurance claims and submit to the proper insurance department with the appropriate coding.

Enters prior authorizations and documents communications, actions, and other data in an informative system.

Research patient medication history to meet insurance criteria.

Research medication insurance formularies for potentially more affordable drug therapies or preferred insurance alternatives by reviewing patient medication history.

Requires knowledge of prior authorization diagnostic ICD codes.

Ensures patients have been cleared for specialty service office visits.

Works directly with Providers and Pharmacy Staff to ensure patients can receive affordable medications

Educate and inform staff of medication prior authorization processes

Navigate and reference the prior authorization health benefit sites to identify current status of prior authorizations/appeals and share with the appropriate care team members.

Assist patients and staff with questions regarding prior authorization status.

Administrative

Assist with filing, copying, faxing, and other clerical duties when time is available and at direction of supervisor.

Provide administrative support for the care team.

Skills & Knowledge

Familiarity/experience with client interaction on the telephone. Typing skills at 30 WPM. Basic personal computer skills and comfort with Microsoft Windows® operating system. EHR experience, EPIC experience a plus.

Who We Are

Mosaic Community Health prides itself on being an innovative health system that pioneers unique and creative ways to provide and improve patient access to health care. Since our founding in 2002 we have proudly served insured and uninsured patients regardless of age, ethnicity, or income.

We focus on a holistic approach to patient care by incorporating behavioral health, pharmacy, and nutrition support to serve patients in the most meaningful way. At Mosaic Community Health, you will work with incredibly dedicated and mission-centered peers and be part of a dynamic team based environment.

Mosaic Community Health offers more than just a job, it is a lifestyle. A lifestyle of serving others. A lifestyle of being an integral part of your community. A lifestyle that offers work/life balance. A lifestyle of enjoying the outdoors! Central Oregon offers over 300 days of sunshine a year, so enjoy a PTO day on the mountain, biking/hiking trails, or the river! A lifestyle that improves lives, including yours. Of course, we also offer a great benefit package!

Qualifications

Education

Required

High School/GED or better

Experience

Preferred

1 year: A minimum of one year of healthcare related customer service or other pharmacy experience. Pharmacy Technician certification preferred. Possess entry-level knowledge of Microsoft Office, Outlook, and Excel. Prior experience with EPIC EHR or supplementary EHR system preferred.

Equal Opportunity Employer

This employer is required to notify all applicants of their rights pursuant to federal employment laws.

For further information, please review the Know Your Rights (https://www.eeoc.gov/poster) notice from the Department of Labor.

Mosaic Medical

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Prescription Refill Specialist