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Overview

The Pharmacy Technician Billing and Insurance Specialist is responsible for processing prescriptions for insurance prior authorizations (PA), coordinating follow-up for denials, reviewing manufacturer funding and assistance as needed, and processing 340B eligible scripts for qualifying patients.

Qualifications

Certifications: Certified Pharmacy Technician within 2 years of license issue date (IL) - Varies; Certified Pharmacy Technician Not Required - Student Pharmacist or Licensed before 1/1/2008 - Exempt/Not Required; Licensed Pharmacy Technician within 60 days of license application - Illinois Department of Financial and Professional Regulation (IDFPR), Education: , Work Experience: Pharmacy tech

Responsibilities

Analyzes information required to complete pre-authorizations with insurance carriers and governmental payors.

Utilizes third party payer/insurance portals to process PA submissions; has a detailed knowledge of insurance providers, their portals and their expectations for authorization approval.

Cross-trains to support additional pharmacy office, prescription processing, filling, and scheduling functions as deemed necessary for optimal business operations.

Assists in supporting all Carle retail pharmacy sites with prior authorization and insurance navigation needs.

Records accurate and thorough documentation on patients' charts to keep all members of patients' care teams informed on status of PAs.

Coordinates any denial follow-up, as indicated.

Performs and records various quality control activities and reports outcomes to the pharmacists and/or manager/supervisor.

Maintain 340B billing protocols and compliance for qualifying patients.

Advocates for patients/providers by processing PA's in a time sensitive manner and collaborating, as indicated with physicians and nurses, to accurately secure clinical information to support the PA submission. Work on behalf of our patients to ensure they are receiving their prescriptions in a timely manner. Collaborate internally with ambulatory departments to identify process improvement opportunities and support department initiatives

About Us

Find it here.

Discover the job, the career, the purpose you were meant for. The supportive and inclusive team where you can thrive. The place where growth meets balance – and opportunities meet flexibility. Find it all at Carle Health.

Based in Urbana, IL, Carle Health is a healthcare system with nearly 16,600 team members in its eight hospitals, physician groups and a variety of healthcare businesses. Carle BroMenn Medical Center, Carle Foundation Hospital, Carle Health Methodist Hospital, Carle Health Proctor Hospital, Carle Health Pekin Hospital, and Carle Hoopeston Regional Health Center hold Magnet® designations, the nation’s highest honor for nursing care. The system includes Methodist College and Carle Illinois College of Medicine, the world’s first engineering-based medical school, and Health Alliance™. We offer opportunities in several communities throughout central Illinois with potential for growth and life-long careers at Carle Health.

_We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. | For more information: [email protected]._

Compensation and Benefits

The compensation range for this position is $20.36per hour - $32.98per hour. This represents a good faith minimum and maximum range for the role at the time of posting by Carle Health. The actual compensation offered a candidate will be dependent on a variety of factors including, but not limited to, the candidate’s experience, qualifications, location, training, licenses, shifts worked and compensation model.

Carle Health offers a comprehensive benefits package for team members and providers. To learn more visit careers.carlehealth.org/benefits.