Purpose

The Pharmacy Technician III (PT III) serves as a point of contact for healthcare providers/patients for their reimbursement and access needs. The PT III will help patients and healthcare providers navigate through reimbursement issues and administer patient support services. In addition, the PT III supports the pharmacist(s) in the practice of pharmacy, including but not limited to obtaining missing information for prescriptions, and reimbursement.

Responsibilities

• Subject matter expert in all Pharmacy Operations, responsible for assisting, mentoring, training and participating in side by sides with team members on prescription processes and reimbursement issues. Successfully complete role based training requirements, including passing certifications and competency assessments prior to conclusion of training period.
• Uses functional expertise in pharmacy and reimbursement expertise to liaise between healthcare providers, insurance companies, hub representatives, and patients to administer the Patient Support Service programs for all pharmacy assets per AbbVie policy and any applicable accreditation standards.
• Accurately assesses each assistance request to determine next steps and comprehensive action plan to resolve or prevent the market access or reimbursement challenges.
• Works independently to manage a caseload comprised of healthcare providers and patients under various levels of urgency dependent upon patient need.
• Holds effective, critical conversations with insurance representatives, healthcare providers, patients, and caregivers and provide education on reimbursement processes specific to their patient's insurance plan.
• Maintains accurate records of actions and conversations in the system; follows up on all outstanding actions in the appropriate timeline to drive effective outcomes. Maintain a work environment that upholds privacy standards required by law and AbbVie.
• Researches, compiles, and maintains education materials with insurance benefit information such as, but not limited to: appeals and denials processes, payor summary plan descriptions, medical policies, formulary listings, fee schedules, etc.
• Initiates and manages patient access contracts which includes but is not limited to letters of agreement and contracts with skilled nursing facilities/hospitals.
• Assists the pharmacist with practice of pharmacy in accordance with federal, state and local regulations, HIPAA guidelines, corporate and departmental policies and procedures; effectively performing the prescriber outreach process (within the legal limits of pharmacy technician authority) to resolve any missing, incomplete, or incorrect information related to prescriptions, medical records, and detailed written orders.
• Disinfect and clean returned medical devices. Process medical device returns and conducts functional inspection and testing on devices as appropriate. will also be responsible for PT I, PT II and additional responsibilities as deemed needed by management.