Research - Laboratory/Non-Laboratory, Staff/Administrative
Join our award-winning team at University of Washington Medical Center (UWMC). Among the top medical centers in the United States, and ranked as the number 1 hospital in Washington State, as rated by U.S. News & World Report 2018-2019 "America's Best Hospitals", UWMC prides itself on compassionate patient care as well as its pioneering medical advances. UWMC is operated by the University of Washington (UW) and serves as a training site for UW's School of Medicine.The UW is proud to be one of the nation's premier educational and research institutions. Our people are the most important asset in our pursuit of achieving excellence in education, research, and community service. Our staff not only enjoys outstanding benefits and professional growth opportunities, but also an environment noted for diversity, community involvement, intellectual excitement, artistic pursuits, and natural beauty. As an employee you will enjoy generous benefits and work/life programs. For a complete description of our benefits for this position, please view this page.UWMC PHARMACY has an opportunity for an AMBULATORY INFUSION AUTHORIZATION SPECIALIST (Full-Time, Days) to identify patients' needs regarding medication and ensure coverage of medication on insurance plans. The Ambulatory Infusion Authorization Specialist is responsible for the direction and control of the Ambulatory Infusion Authorization program for assigned clinics will maximize reimbursement through programs that provide funding or provision of infusion medications. Additionally, the Ambulatory Infusion Authorization Specialist provides insurance authorization, patient assistance program information and education to providers, patients and staff. Responsibilities:Management:
Identify patient needs and ensure coverage of medication on their insurance plan. If not covered, obtain necessary information from medical record, patient and provider to enable justification for Patient Assistance program.
Obtain initial and renewal insurance authorization for infusion medications as required by insurance plans.
Provide infusion cost estimates to patients or clinic staff.
Ensure patients' infusion orders are sent to the appropriate pharmacy or infusion clinic for fulfillment along with any co-pay assistance documentation.
Function as the pharmacy liaison for patients within assigned clinics.
Participate in the Specialty Pharmacy quality management program as part of the Specialty Pharmacy Committee. Develop a plan to improve, streamline, and increase the efficiency and effectiveness of the infusion authorization program. Work with the infusion authorization team to evaluate and further develop systems and processes including: Developing a process for tracking prior authorizations and appeals. Evaluating Patient Assistance Program software for documentation and tracking applications, renewals and patient communication including developing an ROI, budget proposal and implementation plan. Develop processes for products with a Risk Evaluation and Mitigation Strategy (REMS) program for specialty infusion pharmaceuticals.
Participate in revenue cycle committees to help identify causes of denied claims and develop workflow solutions to optimize revenue capture.
Function as patient advocate in order to acquire medication for indigent patients.
Participate in the development, implementation and evaluation of policies and procedures for the infusion authorization program. Assist the pharmacy manager in the development of new policies and procedures and assure timely review and revision of procedures as the program expands. Assure that all program policies and procedures meet state and federal regulations. Provide education to providers, nurses and pharmacy staff when new policies and procedures are developed.Finance:
Maintain a data collection instrument for the infusion authorization program. Documents financial impact of program activities through increased prior authorizations for infusions, medication assistance programs and co-pay assistance programs.
Serve as point of reference for Patient Assistance audits in a timely manner and provide all necessary documentation; patient financial records, signed applications, original orders and proof that the patient
Identify and resolve problems in Patient Assistance and reimbursement and determine compliance for patients of the assigned clinics. Assure resolution of infusion reimbursement and patient assistance issues with patient, provider, third party payor and drug manufacturers to ensure patient access to prescribed infusions. Explores all patient assistance and co-pay program options to minimize infusion write-off's.Education:
Serve as a subject matter expert for physicians, administrators, clinical staff, pharmacy staff, and third party payers for issues regarding ambulatory infusion reimbursement and Patient Assistance programs.
Provide education of Ambulatory Insurance Authorization and Patient Assistance Programs to pharmacy, clinics, social workers and physicians. Assist in developing marketing materials for patients and clinic staff. Make presentations to clinic staff describing services provided including education about medication assistance programs and medication reimbursement issues with ambulatory infusions.
Represent the UWMC Ambulatory infusion program to the different payors; attend seminars and stay updated on ambulatory infusion reimbursement and indigent care plan requirements. Regularly attend staff/clinic meetings regarding the ambulatory infusion and Patient Assistance Program process.
Perform other duties as assigned.
Follow UW Medicine security and confidentiality policies and procedures
Maintain current professional standards and credentials through study materials and education to stay abreast with continuous changes in the health care industry.DESIRED:
Working knowledge of desktop computers, including proficiency with MS Office applications
Highly-detailed organizational skills
Strong interpersonal and communication skills with a customer service background
Interest and aptitude for health-care and information technology
Founded in 1861, the University of Washington is one of the oldest public institutions in the west coast and one of the preeminent research universities in the world. The University of Washington is a multi-campus university comprised of three different campuses: Seattle, Tacoma, and Bothell. The Seattle campus is made up of sixteen schools and colleges that serve students ranging from an undergraduate level to a doctoral level. The university is home to world-class libraries, arts, music, drama, and sports, as well as the highest quality medical care in Washington State and a world-class academic medical center. The teaching and research of the University’s many professional schools provide undergraduate and graduate students the education necessary toward achieving an excellence that will serve the state, the region, and the nation. As part of a large and diverse community, the University of Washington serves more students than any other institution in the Northwest.