Pharmacy Access Rep III - DME

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155 Bellwood Dr, Rochester, New York, United States of America, 14606

• Worker Subtype:
  Regular
• Time Type:
  Full time
• Scheduled Weekly
  
  Hours:
  
  40
• Department: 500160 Pharmacy SMH
• Work Shift:
  
  UR
  - Day (United States of America)
• Range: UR URCB 206 H
• Compensation Range: $21.97 - $29.66

The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job's compensation range, and will be determined by considering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations.

The Pharmacy Access Representative III (PAR) is responsible for the overall management of medical equipment and supplies, coverage determination, and removal of barriers that prevent patients from receiving their equipment. Duties will include insurance coverage verification and determination, patient cost estimation, assembly of documentation necessary to ensure payment for equipment in compliance with payer standards. The PAR will communicate with the prescriber's office to acquire necessary information to submit claims to the patient's insurance for approval including prior authorization and helping educate patients with financial need and arrange timely delivery of the equipment.

The PAR will link communication between the patient, referral source, insurance, and staff to ensure coordinated care.

The PAR will be assigned to a general service area such as hospital discharges and respiratory care Daily tasks are completed independently and prioritized based on the patient and pharmacist needs. Duties of this position require proper judgement, sensitivity, and strict adherence to Strong Memorial Hospital policy on confidentiality and the protection of Private Health Information. The PAR interacts with multiple individuals within the institution including, but not limited to, hospital and clinical employees at various levels including pharmacists, pharmacy technicians, and medical/clinical staff.

External interactions include third party payors, governmental peer review organizations, and referring physicians. To be successful, this individual must have excellent phone etiquette and be open to feedback to create strong collaborative work relationships.

• Coordinates Home Medical Equipment (HME) and supplies referrals and delivery coordination with home medical equipment staff to ensure timely delivery. Troubleshoots insurance issues with referral sources, , physicians and other clinical and internal staff to prevent interruptions in receiving equipment or therapy.
• Acts as liaison between home care coordinators, discharge coordinators DME staff and providers to obtain accurate information related to coverage requirements for medical equipment. Coordinate delivery utilizing various options such as UR DME technicians, UR Couriers and other commercial services.
• Coordinate resupply for consumable items such as CPAP/BIPAP
• Staff HME storefront locations; assist patients with selection and purchase of equipment, as well as educates them on the different options that are covered with their insurance. If insurance does not cover the equipment needed, they support the patient in finding alternative programs to cover the cost of the equipment.
• Follow-up with patients to ensure safe and effective equipment use. Documents problems with the equipment (i.e. delivery issues, broken equipment, monitors CPAP and other respiratory equipment use and adherence, difficulty with use, etc.) and triages issues to management and clinical staff as appropriate.
• Coordinates medical equipment ordering with inventory manager. Tracks…