Patient Financial Counselor - Pharmacy

Mission Statement: Michigan Medicine improves the health of patients, populations and communities through excellence in education, patient care, community service, research and technology development, and through leadership activities in Michigan, nationally and internationally. Our mission is guided by our Strategic Principles and has three critical components: patient care, education and research that together enhance our contribution to society.

About the Role

This 1.0 FTE position is dedicated to 100% patient care as a pharmacy financial coordinator within the pharmacy program, reporting directly to the PFC Supervisor.

Responsibilities

• Coordinate medication access and financial assistance for Michigan Medicine pharmacy patients.
• Perform pharmacy insurance benefit investigations.
• Complete pharmacy prior authorizations (PAs).
• Coordinate prescription drug appeals.
• Coordinate medication financial assistance enrollment (copay cards, patient assistance programs, etc.) for eligible patients.
• Assist in miscellaneous coordination and follow-up with providers and MM pharmacy to ensure timely access to medication therapy.
• Core functions include:
  • Obtaining detailed prescription insurance information to adjudicate claims.
  • Communicating complex pharmacy benefit insurance and financial information relating to specialty and non-specialty medications to patients and internal and external customers.
  • Evaluating patient-specific medication, insurance, and financial situations and providing counseling relating to coverage terms, benefits, and related requirements.
  • Submitting prior authorizations for medication coverage through pharmacy and/or medical insurance.
  • Assisting eligible patients in navigating access to manufacturers and extended coverage options.
  • Troubleshooting and resolving complex pharmacy benefit billing issues associated with specialty and non-specialty medications.
  • Identifying, developing, and implementing additional quality improvement initiatives to improve the team's efficiency and decrease turnaround time for patient access to medication.

Requirements

• Graduation from high school or equivalent of education and experience.
• Minimum of 3-5 years of prior authorization experience through pharmacy benefit with progressive levels of responsibility.
• Knowledge of medical and prescription insurance company policies and requirements (i.e., Medicare, Social Security, Medicaid, and Medicare Part D).
• Ability to work in a fast-paced environment, consistently problem-solving and managing time efficiently and productively.
• Ability to work well as part of a team with minimal supervision.
• Ability to manage time-sensitive information while maintaining strict patient confidentiality.
• Excellent written and verbal communication skills.
• Excellent customer service skills.

Qualifications

• Bachelor's or associate degree in a healthcare-related field (desired).
• Analytical and computing skills with Word and Excel programs (desired).
• Experience with Epic and/or other billing and pharmacy dispensing programs (desired).
• Ability to perform a variety of manual dexterity movements, including keyboarding; fluency in reading, writing, and speaking English (desired).
• Ideal candidate must be patient-centered, flexible, adaptable to change, innovative, and willing to take on tasks/responsibilities with autonomy and creativity.

Why Join Michigan Medicine?

Michigan Medicine is one of the largest health care complexes in the world and has been the site of many groundbreaking medical and technological advancements since the opening of the U-M Medical School in 1850. Michigan Medicine is comprised of over 30,000 employees, and our vision is to attract, inspire, and develop outstanding people in medicine, sciences, and healthcare to become one of the world's most distinguished academic health systems.

Benefits

• Excellent medical, dental, and vision coverage effective on your very first day.
• 2:1 Match on retirement savings.

Positions that are eligible for hybrid or mobile/remote work mode are at the discretion of the hiring department. Work agreements are reviewed annually at a minimum and are subject to change at any time, and for any reason, throughout the course of employment.

This position is covered under the collective bargaining agreement between the U-M and the Service Employees International Union (SEIU), which contains and settles all matters with respect to wages, benefits, hours, and other terms and conditions of employment.