PROGRAM OPERATIONS SPECIALIST – BILLING/MEDICATION ASSISTANCE COORDINATOR (FULL-TIME, DAY SHIFTS)

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 .

UW MEDICAL CENTER - MONTLAKE - PHARMACY has an opportunity for an PROGRAM OPERATIONS SPECIALIST – BILLING/MEDICATION ASSISTANCE COORDINATOR (Full-Time, Day Shifts). The Program Operations Specialist: Billing/Medication Assistance Coordinator is responsible for the development, maintenance and enhancement of billing and reimbursement of outpatient medications and the patient medication assistance program (MAP) for both inpatient and ambulatory care at UMWC. The position routinely makes financial decisions to approve patient eligibility, continuing coverage for eligibility within the billing and reimbursement for outpatient medications. The position will provide information and education to providers, patients, pharmacy and other medical center staff and requires close interaction with UWMC pharmacists, management team members, Social Work, Finance, Billing and Compliance.

RESPONSIBILITIES:

Management:
• Evaluate patient pharmacy benefits to ensure coverage of outpatient prescription medications.
• Maintain current knowledge of all aspects of industry sponsored medication assistance programs.
• Determine and coordinate patient eligibility for medication reimbursement programs or facilitate pharmacy benefit management with managed care and federal or state assistance prescription programs.
• Develop and maintain systems and workflows to support standardized medication assistance programming.
• Determine patient eligibility for the MAP and work collaboratively with Patient Financial Services, Social Work and other medical center personnel to ensure clinical and financial documentation is complete for program enrollment.
• For patients who are eligible for the MAP: manage the application process, reminders for reordering, eligibility verification, current drug list and current application forms. This includes reminders to patients to contact programs for refills, set up shipments on a monthly basis. Maintain all required patient documentation as required by individual programs.
• Assume responsibility for the accountability, storage and distribution of the MAP inventory. Perform monthly audits to ensure all drug received is utilized appropriately and recorded accurately.
• Lead development, implementation and evaluation of policies and procedures for the pharmacy billing and Medication Assistance Program.
• Review, analyze and implement process improvements in operational areas related to billing, reimbursement and medication assistance programs.

Finance:
• Utilize system reporting tools to prepare monthly reporting to demonstrate MAP impact. Report monthly to pharmacy administration and finance.
• Serve as audit coordinator in the event of a pharmacy billing or medication assistance audit, providing necessary documentation, and audit response as necessary.

Education:
• Serve as primary resource to patients, pharmacy staff, medical center staff and providers as well as outside payers for issues regarding pharmacy billing, reimbursement and industry sponsored medication assistance programs.
• Provide training and education to new staff regarding the pharmacy’s billing practices and policy and procedures related to billing.
• Provide training and education for all pharmacy and other medical center personnel regarding the referral of patients to the MAP and the program requirements.
• Represent the UWMC Ambulatory Pharmacy to the industry sponsored medication assistance programs.  Attend seminars and stay up-to-date on billing, reimbursement, indigent care plan, and assistance plan requirements.

Other:
• Perform the duties of a Pharmacy Technician 1 and 2.
• Perform other related duties as required.
• Adhere to the  UW Medicine Privacy, Confidentiality, and Information Security Agreement
• Promote the image of service and good will to patients, the public and all medical center personnel.
• Maintain high and current professional standards and credentials through study materials, education and training to stay abreast with the continuous changes in the industry sponsored medication assistance programs and insurance coverage issues.