Under general supervision of a pharmacist and in conjunction with clinical staff, responsible for completing various aspects of providing access to medications for patients.
Responsible for providing access to medications for patients by completing prior authorization requests (PAR), Co-pay assistance programs, medication assistance programs, benefits investigation, coordinating refill renewal requests, managing PAR and prescription renewal dates, and assisting patients without health insurance to connect with the Enrollment department as applicable. Clinical and technical knowledge is utilized to operate web based applications, work in Microsoft Word and Excel, and analyze and audit pharmacy usage reports.
* Serve as a referral point and as the expert in submitting applications for patients to receive provided drug and co-pay assistance from pharmaceutical manufacturer assistance programs* Coordinate applications for assistance meeting drug-specific requirements for participation, including but not limited to forms, patient proof of income, relative clinical information, and physician or provider signature.* Track each request to achieve timely approval & follow-up with appropriate individuals when not approved* Displays effective file management by maintaining documentation and detailed records of program participation, medications dispensed, and value of medications provided to patients via the Medication Assistance Program.* Completes consistent documentation in the electronic health record per program standard of practice.* Effective analysis and use of management data and reports to establish standards to monitor and improve contract performance.
*Works with the Enrollment Services Department
*Directly enroll eligible patients into manufacturer patient assistance and co-pay programs
*Collaborate with other departments providing pharmacy related information to nurse case managers, complex case workers, health coaches, and patient navigators.
*Work cooperatively with other staff members and clinic staff.
*Other duties as assigned.
Knowledge, Skills & Abilities
* Extensive knowledge of health care administration, including Medicare, managed care, Medicaid and CHP+ eligibility and enrollment processes. * Extensive knowledge of eligibility determination systems. * Knowledge of federal and Colorado statutes, legislative initiatives and regulations, as well as federal, State and local policies. * Ability to disseminate program information, policies, rules and/or regulations. * Ability to simultaneously coordinate and manage several functions, programs, and projects in various stages of completion. * Ability to consistently implement program, department and organizational policies and procedures. * Demonstrates exceptional interpersonal and customer service skills in all interactions with internal and external healthcare team members. * Demonstrates exceptional interpersonal and customer service skills in all interactions with patients. * Understands how state and federal laws, regulations, policies and procedures impact specific job responsibilities and functions.* Demonstrates actions to reasonably prevent, detect, and report unethical and unlawful business practices.
Computers and Technology
*Proficiency with Epic, preferred
*Proficiency in MS Office Suite, required.
* High School Diploma or GED (Required) Three (3) years of pharmacy technician experience or equivalent experience performing prior authorizations, required.
* PTCB Certified Pharmacy Technician (Required) Pharmacy Technician Certification with Colorado SBOP, required. All Certifications and Licenses required for this job must be kept current as a condition of continued employment.Pharmacy Technician Certification with Colorado SBOP, required. All Certifications and Licenses required for this job must be kept current as a condition of continued employment.
Work Type Full time
All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made.
Denver Health is an integrated, efficient, high-quality academic health care system that is considered a model for the nation. The Denver Health system includes the Rocky Mountain Regional Level I Trauma Center, a 525-bed acute care medical center, Denver's 911 emergency medical response system, 8 family health centers, 15 school-based health centers, the Rocky Mountain Poison and Drug Center, the Denver Public Health Department, an HMO, and The Denver Health Foundation.
As Colorado's primary safety net institution, Denver Health is a mission-driven organization that has provided more than $3.3 billion in care for the uninsured in the last ten years. Denver Health is a leader in performance and quality improvements and remains financially secure, in part, due to its nationally recognized implementation of lean principles in healthcare. Denver Health is a major resource to the community, serving approximately 185,000 individuals and 67,000 children a year.
Located just south of downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.
We strongly support diversity in the workforce and Denver Health is an equal opportunity employer (EOE).
"Denver Health is committed to provide equal treatment and equal employment opportunities to all applicants and employees. Denver Health is an Equal Opportunity Employer and does 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."
Internal Number: 1590
About Denver Health
Take your career to the next level at Denver Health, where we offer a robust benefits package and endless opportunities for growth. Denver Health is a nationally-ranked, locally-trusted, premier healthcare institution located in the heart of Denver, Colorado.Twenty-five percent of all Denver residents, or approximately 150,000 individuals, receive their health care here. We are known as an integrated health care system that encompasses multidisciplinary academic specialties, a community health system, a level I adult trauma center, pediatric emergency and urgent care center home to Denver Public Health and many of the nation’s leaders in medicine.