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About the Role

The Pharmacy Access Representative III (PAR) manages medical equipment and supplies, determines coverage, and removes barriers to patient access. This role involves insurance verification, patient cost estimation, and coordinating with prescribers and payors to ensure timely delivery and payment for equipment.

Responsibilities

• Manage medical equipment and supplies, including coverage determination and barrier removal.
• Verify insurance coverage and determine patient costs.
• Assemble documentation for insurance claims and prior authorizations.
• Communicate with prescribers' offices to obtain necessary information for claims.
• Educate patients on financial assistance programs and arrange equipment delivery.
• Liaise between patients, referral sources, insurance, and staff for coordinated care.
• Coordinate Home Medical Equipment (HME) and supplies referrals and delivery.
• Troubleshoot insurance issues with referral sources, physicians, and staff.
• Act as a liaison for accurate coverage information and coordinate delivery logistics.
• Coordinate resupply for consumable items.
• Staff HME storefronts, assist patients with equipment selection and purchase, and educate on insurance coverage.
• Follow up with patients to ensure safe and effective equipment use and document issues.
• Coordinate medical equipment ordering with the inventory manager and track ordering trends.
• Make scheduled calls to patients for resupply needs and facilitate adherence to treatment.
• Provide excellent customer service by triaging patient calls and answering promptly.
• Monitor and reconcile patient self-pay accounts monthly.
• Maintain expertise on insurance coverage and requirements for home medical equipment.
• Retrieve and evaluate referrals to verify insurance coverage and contract for equipment.
• Advise patients on out-of-pocket costs, considering deductibles, coinsurance, and copayments.
• Determine if equipment meets payer coverage requirements and assemble necessary information.
• Communicate out-of-pocket costs to patients, caregivers, or coordinators.
• Identify coverage gaps and utilize resources like social work and charity care.
• Serve as a subject matter expert on alternative payment methods.
• Create and confirm sales orders and collaborate with service lines for billing information.
• Analyze high-cost equipment cases and identify optimal options for patients.
• Collaborate with social services and case management on patient assistance.
• Remain professional, courteous, and diligent in all interactions.
• Obtain high patient and provider satisfaction results.
• Report errors and contribute to quality improvement initiatives.
• Assist with payer audits and ensure timely completion of patient documentation.
• Coordinate required information for denied claims and participate in payer audits.
• Assist with training new team members.
• Perform other related duties as required.
• Maintain expertise on prior authorization policies for common payors.
• Submit and monitor prior authorization requests timely.
• Initiate, document, and track all prior authorizations to improve patient experience and ensure compliance.

Requirements

• At least 18 years of age at the time of application.
• Associate’s degrees in a Medical, Secretarial, or related field and 4 years of relevant experience required.
• Equivalent combination of education and experience.
• Capable of working independently with minimum supervision.
• Strong communication skills, problem-solving abilities, and professional presentation required.
• Demonstrated customer relations skills required.
• Ability to multi-task, manage many details with accuracy, work under pressure, and maintain a professional attitude required.

Skills

• Excellent phone etiquette
• Openness to feedback
• Strong communication skills
• Problem-solving abilities
• Professional presentation
• Customer relations skills
• Multi-tasking
• Accuracy in managing details
• Ability to work under pressure
• Professional attitude

Location

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

Work Type

• Regular
• Full time

Experience Level

• 4 years of relevant experience

Education Level

• Associate’s degrees in a Medical, Secretarial, or related field
• Equivalent combination of education and experience

Salary/Compensations

• $21.97 - $29.66

About the Company

• The University of Rochester is committed to fostering, cultivating, and preserving an inclusive and welcoming culture to advance the University’s Mission to Learn, Discover, Heal, Create – and Make the World Ever Better.

Equal Opportunity

• The University is committed to not discriminating on the basis of age, color, disability, ethnicity, gender identity or expression, genetic information, marital status, military/veteran status, national origin, race, religion, creed, sex, sexual orientation, citizenship status, or any other characteristic protected by federal, state, or local law (Protected Characteristics). This commitment extends to non-discrimination in the administration of our policies, admissions, employment, access, and recruitment of candidates, for all persons consistent with our values and based on applicable law.