The Patient Business Associate facilitates enrollment and assist patients enrolled in the Specialty Pharmacy in navigating the complexities of their insurance benefits and additional resources, in order to increase access to and to minimize patient out-of-pocket expense on important specialty medications.
Key responsibilities and accountabilities may include:
Obtain detailed insurance benefit information including but not limited to; appropriate billing information (medical vs prescription covered benefit) retail and mail order prescription co-pays, network pharmacies, plan formulary, prior authorization requirements, and other necessary information to successfully adjudicate a specialty medication claim.
Evaluate patients medication, insurance, and financial situation and counsel them regarding their prescription insurance coverage, benefits, and related requirements, as well as the resources available through various channels (insurance, drug manufacturers, charity care, etc) to ensure affordable access to specialty medications.
Ability to train, share knowledge and expertise with colleagues, and develop and implement process improvements.
Evaluate medication orders to determine appropriate interventions, including prior authorizations, appeals and financial assistance.
Assist patients with the necessary documentation needed to apply for extra help, charity care, manufacturer drug assistance, Medicaid, and/or other qualifying insurance or assistance programs. Maintain regular contact with patients to ensure smooth and timely transition into these programs, with minimal to no interruption in therapy.
Proactively monitor patients insurance for changes in benefits and coverage, update billing information in appropriate systems when necessary, and maintain consistent communication with the patient as needed.
Contact patients with outstanding pharmacy balances and facilitate payment arrangements.
Document all patient interactions in appropriate systems and databases, including MiChart, TheraDoc, Otis and QS1.
Stay abreast of current regulations and requirements of insurance companies, assistance programs and other medication resources.
Act as a resource and effectively communicate complex insurance and financial information associated with specialty medications to all areas within the medical center including clinics and providers as well as insurance companies, patients, and their families. Participate in patient education programs, including group classes and one on one teaching.
Facilitate patient enrollment or transition to a non-UMHS pharmacy when needed based on patients' insurance requirements to ensure uninterrupted access to their specialty medication.
Candidates should have an associate degree in a healthcare-related field and/or experience in a pharmacy or medical office setting with strong background in insurance benefits, billing and verification, and patient financial counseling.
Candidates with an equivalent combination of 3-5 years of education and/or experience may be considered.
Excellent written and verbal communication skills.
Outstanding customer service skills.
Bachelor's degree is preferred.
Ability to work well in a team as well as independently with minimal supervision, consistently problem solving and managing time in an efficient and productive manner.
Proven record of accomplishment in researching and resolving complex insurance issues.
Proven record of accomplishment in building credibility and strong relationships with colleagues, healthcare providers, patients, and supported departments and staff.
Strong knowledge of medical and prescription insurance company policies and requirements (i.e. Medicare, Social Security, Medicaid, and Medicare Part D).
Ability to handle fast-paced, time-sensitive information while maintaining strict patient confidentiality
Strong analytical, organizational, and computing skills with Word and Excel programs.
Experience with OTIS, Thera-Doc Michart, NRX, Webdenis, and other relevant billing and verification programs.
This position may be underfilled at a lower classification depending on the qualifications of the selected candidate.
University of Michigan Health System conducts background screening and pre-employment drug testing on job candidates upon acceptance of a contingent job offer and may use a third party administrator to conduct background screenings. Background screenings are performed in compliance with the Fair Credit Report Act.
The University of Michigan Health System improves the health of patients, populations and communities through excellence in education, patient care, community service, research and technology development, and through leadership activities in Michigan, nationally and internationally. Our mission is guided by our Strategic Principles and has three critical components; patient care, education and research that together enhance our contribution to society.
Job openings are posted for a minimum of seven calendar days. This job may be removed from posting boards and filled anytime after the minimum posting period has ended.
The University of Michigan is an equal opportunity/affirmative action employer.
A great university is made so by its faculty and staff, and Michigan is recognized as one of the best universities to work for in the country. The Michigan culture is known for engaging faculty and staff in all facets of the university to create a workplace that is vibrant and stimulating.For two consecutive years, the Chronicle of Higher Education has placed U-M in its "Great Colleges to Work For..." survey. In particular, the university earns high marks for strong relations between faculty and administrators, a collaborative system of governance, strong pay and benefits, and a healthy work/life balance.