Imagine a career at one of the nation's most advanced health networks.

Be part of an exceptional health care experience. Join the inspired, passionate team at Lehigh Valley Health Network, a nationally recognized, forward-thinking organization offering plenty of opportunity to do great work.

LVHN has been ranked among the "Best Hospitals" by U.S. News & World Report for 23 consecutive years. We're a Magnet(tm) Hospital, having been honored five times with the American Nurses Credentialing Center's prestigious distinction for nursing excellence and quality patient outcomes in our Lehigh Valley region. Finally, Lehigh Valley Hospital - Cedar Crest, Lehigh Valley Hospital - Muhlenberg, Lehigh Valley Hospital- Hazleton, and Lehigh Valley Hospital - Pocono each received an 'A' grade on the Hospital Safety Grade from The Leapfrog Group in 2020, the highest grade in patient safety. These recognitions highlight LVHN's commitment to teamwork, compassion, and technology with an unrelenting focus on delivering the best health care possible every day.

Whether you're considering your next career move or your first, you should consider Lehigh Valley Health Network.

Summary
Responsible for global patient financial support to any patient receiving services in the Specialty Pharmacy. The overall goal is to improve the patient experience by alleviating the financial burden with a focus on our uninsured and underinsured patient population. This is done by reducing the burden of out-of-pocket responsibilities by facilitating patient enrollment in internal and external assistance programs. This is done while simultaneously protecting the hospital revenue by obtaining maximum internal referral capture rate and reimbursement for our high dollar treatments.

Job DutiesReview of Specialty Pharmacy referrals to ensure optimal insurance coverage for the patient including medical necessity, obtaining proper authorization, performing benefit and eligibility verification for all new patients/new insurances, and pharmacy determination. Must be able to differentiate between pharmacy benefit and medial benefit requirements. Manages the Free Market Health (FMH) platform including internal referral management and ongoing documentation needs Understands 340B Drug Program qualification rules and uses qualification to determine rate agreements, as in the case with FMH. Expert on external resources such as Pharmaceutical Drug Replacement programs, copay relief programs, PATH, PACE and foundational support Expert on internal resources such as pharmacy charity cards, patient financial assistance program (FAP) and hardship programs Collaborates with financial services and pharmacy stakeholders to resolve issues pertaining to authorization and medical necessity denials to obtain maximum reimbursement. Works in coordination with the patient's clinical team to ensure coverage of services to achieve the best outcome for the patient. Maintains current and detailed knowledge of all third-party payer requirements and changes as well as posted policy updates and regulatory standards.
Minimum QualificationsBachelor’s Degree in related healthcare field or equivalent experience 3 years In a pharmacy setting in Oncology or other specialization, coding, billing, registration, insurance verification/authorization. Ability to anticipate and understand customer financial needs and work through complex treatment scenarios Communicate patient needs to appropriate personal Demonstrate expert knowledge in determining 3rd party insurance pharmacy or medical benefits and billing requirements Must be able to maintain confidentiality and have an understanding of patient’s rights Must understand specialized treatments and related insurance coverage issues, including rules governing medical necessity Must possess the ability to combine compassion with strong professional skills Proficient in medical terminology, word processing & spreadsheet software as well as schedule/billing systems. Knowledge of PC operations including Excel
Preferred Qualifications5 years In a pharmacy setting in Oncology or other specialization, coding, billing, registration, insurance verification/authorization Knowledge of the 340B Drug Program
Physical Demands
Lift and carry 25 lbs. frequent sitting/standing, frequent keyboard use, *patient care providers may be required to perform activities specific to their role including kneeling, bending, squatting and performing CPR.

Job Description Disclaimer: This position description provides the major duties/responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require.

Lehigh Valley Health Network is an equal opportunity employer. In accordance with, and where applicable, in addition to federal, state and local employment regulations, Lehigh Valley Health Network will provide employment opportunities to all persons without regard to race, color, religion, sex, age, national origin, sexual orientation, gender identity, disability or other such protected classes as may be defined by law. All personnel actions and programs will adhere to this policy. Personnel actions and programs include, but are not limited to recruitment, selection, hiring, transfers, promotions, terminations, compensation, benefits, educational programs and/or social activities.

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Lehigh Valley Health Network does not accept unsolicited agency resumes. Agencies should not forward resumes to our job aliases, our employees or any other organization location. Lehigh Valley Health Network is not responsible for any agency fees related to unsolicited resumes.

Work Shift:

Day Shift

Address:

2024 Lehigh St

Primary Location:

Allentown - 2024 Lehigh Street

Position Type:

Onsite

Union:

Not Applicable

Work Schedule:

8:30a-5p M-F

Department:

1004-09058 LVPS Specialty - CC