Pharmacy Access Representative III - DME

Responsibilities

• Overall management of medical equipment and supplies
• Coverage determination and removal of barriers for patients
• Insurance coverage verification and determination
• Patient cost estimation and documentation preparation
• Communication with prescriber’s office for claim submission
• Helping patients with financial need and arranging timely delivery
• Linking communication between patient, referral source, insurance, and staff
• Home Medical Equipment Coordination
• Referrals and delivery coordination with home medical equipment staff
• Troubleshooting insurance issues with referral sources, physicians, and staff
• Liaison between home care coordinators, discharge coordinators, and DME staff
• Supporting patients with alternative programs to cover equipment costs
• Follow-up with patients to ensure safe and effective equipment use
• Documenting problems with equipment and triaging issues
• Coordinating medical equipment ordering with inventory manager
• Tracking changes in ordering trends and coordinating with inventory manager
• Making scheduled calls to patients for resupply needs and setting up deliveries
• Monitoring adherence to treatment and communicating with patients and clinical staff
• Providing excellent customer service
• Reconciling patient self-pay accounts monthly
• Maintaining expertise on insurance coverage and requirements for home medical equipment
• Evaluating home medical equipment referrals and verifying insurance coverage
• Obtaining benefit information from third party payers and advising patients on expected out-of-pocket costs
• Determining if equipment meets payer requirements for coverage
• Retrieving and assembling necessary information for insurance coverage qualifications
• Communicating out-of-pocket costs to patients and identifying coverage gaps
• Serving as a subject matter expert on alternative payment methods
• Collaborating with social services and case management on patient assistance
• Ensuring compliance and quality in all interactions
• Participating in payer audits and collecting, summarizing, and sending requested information
• Assisting with training of new team members

Qualifications

• At least 18 years of age at the time of application
• Associate’s degree in a Medical, Secretarial, or related field and 4 years of relevant experience required
• Completed ASHP-accredited training program or equivalent experience as a pharmacy technician preferred
• Certification from a nationally accredited pharmacy technician certification program (Currently PTCB) and maintain ongoing education requirements preferred