Patient Assistance Specialist - 127896

UC San Diego Health's Pharmacy department supports the organization's mission to deliver outstanding patient care and to create a healthier world - one life at a time. We are a diverse, patient-focused, high-performing team with a commitment to quality, collaboration, and continuous improvement that enables us to deliver the maximum standard of care to our patients. We offer challenging career opportunities in a fast-paced and innovative environment and we embrace individuals who demonstrate a deep passion for problem-solving and customer service.The Insurance & Patient Biller III is responsible for the full range of patient assistance and some pharmacy billing duties within the prescription billing cycle from claim generation to final pharmacy payment disposition. The Insurance & Patient Biller III will monitor, prioritize and ensure assigned work for the resolution of pharmacy claims, resolution of edits, attaching of records and all actions required to resolve open requests are being addressed in a timely manner and in accordance with current departmental standards and performance metrics. The Insurance & Patient Biller III works closely with internal customers and external business partners to take any and all assigned actions required to ensure the accurate and timely billing / resolution of claims for our patients.

MINIMUM QUALIFICATIONS

Medical Terminology training and / or certificate or equivalent experience.

Minimum of three (3) years of medical and pharmacy claims billing, denial mitigation and appeals.

Extensive knowledge of pharmacy and medical insurance billing / processes, billing documents, claim forms, HIPAA, PHI, and a thorough understanding of state and federal rules for billing and appealing pharmacy and medical claims. Knowledge of eligibility criteria of pharmaceutical companies and foundations.

Strong proficiency with MS Office Products (Mail, Excel and Word).

Detail oriented, with organizational skills and the ability to manage time efficiently, prioritize tasks, and complete assignments consistently on schedule

Basic communications skills, with the ability to interpret and present clinical financial information clearly and concisely

PREFERRED QUALIFICATIONS

• Extensive knowledge in navigating Epic (Electronic Medical Record).
• Familiar with reading medical and pharmacy records in order to submit records to support medical necessity based on diagnosis and services rendered.
• Clear understanding or know how to properly obtain the different types of payer information timely and how to prioritize workload based on the payer specific info.
• Capable and comfortable with verifying patient coverage / insurance verification and adjudication via a payer portal, Epic system or by phone.
• Knowledge of reporting instruments and metrics on a monthly basis.
• Knowledge of acquisition no-cost drug programs.
• Bilingual (Spanish preferred).
• Knowledge of reviewing, analyzing and managing assistance contracts between patients and drug companies.

SPECIAL CONDITIONS

Pay Transparency Act

Annual Full Pay Range : $56,522 - $70,261 (will be prorated if the appointment percentage is less than 100%)

Hourly Equivalent : $27.07 - $33.65

Factors in determining the appropriate compensation for a role include experience, skills, knowledge, abilities, education, licensure and certifications, and other business and organizational needs. The Hiring Pay Scale referenced in the job posting is the budgeted salary or hourly range that the University reasonably expects to pay for this position. The Annual Full Pay Range may be broader than what the University anticipates to pay for this position, based on internal equity, budget, and collective bargaining agreements (when applicable).