• Performs complex and unique duties within the pharmacy department
• Interpret, evaluate, and summarize information and datasets of varying sizes
• Communicate effectively and professionally with stakeholder inside and outside of pharmacy department
• Develop and maintain internal (within Fred Hutch) and external relationships (such as vendors, payors, distributors)
• Work independently and within teams to complete tasks
• Documentation information or results in clear and concise ways
• Generate and present reports of tasks to Pharmacy Operations Manager or Director of Pharmacy
• Other duties as assigned
• Determine benefit limits and secure insurance approvals for specialty infusion, oral chemotherapy and high-cost medications
• Work closely with care team to communicate any coverage issues
• Evaluate patterns in denied claims taking corrective action and educating staff as needed
• Liaison with Patient Financial Services
• Serve as a resource to patients and staff regarding insurance and drug coverage questions
• Provide patient assistance program information and education to providers, patients and medical center staff
• Completing and submitting prior authorization forms and patient assistance applications
• Reprocessing denied or rejected third party claims
• Train and educate staff on pharmacy billing functions
• Participate in billing related meetings
• Retail pharmacy reconciliation and reporting
• Other pharmacy related duties in accordance with regulations under Washington State Pharmacy Quality Assurance Commission

Required:

• High school diploma or equivalent
• Current Washington state pharmacy technician certification.
• 2 years pharmacy technician experience
• Proficient in Microsoft suite
• Ability to communicate verbally in person, on the phone, and in writing in a clear, concise and professional manner
• Ability to use a mouse, navigate computer programs, enter data into computer systems accurately and efficiently
• Attention to detail and accuracy documentation of information
• Ability to multitask and work efficiently in a dynamic work environment
• Ability to work effectively as a member of a team
• Experience with electronic medical records
• Familiar with the generic names of drugs along with their basic indication
• Able to perform basic pharmaceutical calculations
• Review and correct discrepancies identified in daily, weekly and monthly billing reports
• Ability to work in a fast paced and complex environment

Preferred:

• Previous experience in pharmacy billing/prior authorization
• Knowledge of CPT, ICD-10 and other medical terminology
• Knowledge of the health care environment and electronic medical records
• Attention to detail and accuracy documentation of information
• Ability to multitask and work efficiently in a dynamic work environment
• Ability to work effectively as a member of a team
• Experience with electronic medical records[GK1]