Pharmacy Authorization & Financial Assistance

Northside Hospital is award-winning, state-of-the-art, and continually growing. Constantly expanding the quality and reach of our care to our patients and communities creates even more opportunity for the best healthcare professionals in Atlanta and beyond. Discover all the possibilities of a career at Northside today.

Analyzes insurance coverage for transplant and identifies coverage issues impacting the transplant patient. Determines possible alternate sources of coverage through healthcare and community agencies and resources, and works directly with patients and clinical coordinators to help resolve. Coordinates the lodging process for patients coming for transplant from outside the metro area, and handles direct bill invoicing from hotels, lodging fund financial assistance, and Hope Lodge. Obtains insurance authorization for lodging, inpatient and outpatient services, and medication. Obtains insurance prior approval for transplant and meets with patients for insurance coverage review for selected group of patients.

PRIMARY DUTIES AND RESPONSIBILITIES

1. Performs comprehensive insurance assessment at time of initial referral, including coverage for outpatient pharmacy for oral medications, outpatient intravenous medications and chemotherapy, HLA tissue typing for patient and siblings, matched unrelated donor search, home health and bone marrow transplant. Reviews transplant benefits with patient, including coverage for pre-transplant, transplant and post-transplant process. Provides pertinent information to clinical coordinators, Pharm. D., NSH case manager, and other members of transplant team. Documents information in database and clinical application. Re-verifies insurance coverage as appropriate.
2. Coordinates lodging process for transplant patients; determines means of payment for lodging (i.e., self pay, lodging fund, insurance benefits, global contract, Hope Lodge, other assistance funds), and obtains travel benefits and authorization from insurance case manager. Works with clinical coordinators to determine dates needed. Arranges direct bill stays, tracks invoices and payments. Obtains initial approval for direct bill from department manager and provides weekly updates. Tracks lodging information in database and provides reports for team.
3. Works with patients who have limited or no insurance coverage for transplant (e.g., lack donor benefits, search benefits, outpatient prescription coverage, have per transplant maximums, cobra exhausted, etc.) and identifies alternate resources. Uses NMDP material and other means to research transplant assistance options. Coordinates financial assistance application process. Tracks coverage issues throughout the transplant process and provides team with weekly report from database. Provides quarterly summary reports.
4. Works closely with clinical coordinators, PA's, and financial coordinator and obtains authorizations for services during the transplant period, including medication and lodging. Researches denials for authorization and helps resolve. Documents information in benefits database and clinical application. Produces tracking reports.
5. Obtains insurance prior approval for transplant, maintains contact with case managers and meets with patients for insurance coverage review for selected group of patients

REQUIRED:

1. Two (2) years of college or associate degree, or 5 years experience in healthcare financial services.
2. Strong computer skills-demonstrated knowledge of computer skills and software applications, including financial spreadsheet and Windows applications.

PREFERRED:

1. Bachelor's Degree
2. Demonstrated knowledge of healthcare financial services