Overview:
The Specialty Pharmacy Account Coordinator I plays a critical role in supporting patients through complex medication therapies by coordinating insurance, financial assistance, and pharmacy services. This position works under the direct supervision of a pharmacist and in compliance with all federal and state regulations.
Key Responsibilities:
Patient Account Coordination:
Process patient accounts efficiently and accurately in assigned sections.
Verify insurance eligibility, benefits, and pre-certification requirements, including for infused medications.
Ensure compliance with medical necessity criteria and payer policies (e.g., FDA, NCCN).
Manage denials, identify root causes, and recommend process improvements.
Financial Assistance & Program Management:
Identify and enroll patients in applicable assistance programs (e.g., copay cards, foundations, PAPs).
Collect and submit required documentation on behalf of patients.
Track application status and ensure timely follow-up.
Register patients for drug replacement programs and appeal insurance denials when necessary.
Pharmacy Operations Support:
Function as a Senior Pharmacy Technician as needed.
Prepare and fill medication orders under pharmacist supervision.
Maintain and secure drug inventory; deliver medications post-verification.
Retrieve and credit unused medications appropriately.
Leadership & Quality Assurance:
Monitor workflow and conduct quality audits.
Assist in training and development of coworkers.
Lead task forces and contribute to new program implementation.
Recommend and help implement procedural improvements.
Communication & Collaboration:
Serve as a resource for staff and patients.
Communicate effectively with physicians, insurance companies, and internal teams.
Address complex patient concerns and model professional behavior.
Compliance & Development:
Stay current on insurance regulations and billing guidelines.
Complete all mandatory training and pharmacy competencies.
Participate in quality assurance and medication use evaluation programs.
Qualifications:
High school diploma or equivalent required; associate degree or higher preferred.
Experience in pharmacy operations, insurance verification, or healthcare billing strongly preferred.
Strong knowledge of specialty pharmacy, oncology billing, and patient assistance programs.
Excellent communication, organizational, and problem-solving skills.
Proficiency in pharmacy systems and Microsoft Office Suite.
From day one, Mercy offers outstanding benefits - including medical, dental, and vision coverage, paid time off, tuition support, and matched retirement plans for team members working 32+ hours per pay period.
Join a caring, collaborative team where your voice matters. At Mercy, you'll help shape the future of healthcare through innovation, technology, and compassion. As we grow, you'll grow with us.