Financial Counselor - Specialty Pharmacy

 
Position: Financial Counselor - Specialty Pharmacy

Job ID: 151221

Location: US-TX-Houston

Department: SPECIALTY PHARMACY

Talent Area: Finance

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8a - 5p

About Texas Children's Hospital

Since 1954, Texas Children’s has been leading the charge in patient care, education and research to accelerate health care for children and women around the world. When you love what you do, it truly shows in the smiles of our patient families, employees and our numerous accolades such as being consistently ranked as the best children’s hospital in Texas, and among the top in the nation by U.S.News & World Report as well as recognition from Houston Business Journal as one of this city’s Best Places to Work for ten consecutive years.   Texas Children’s comprehensive health care network includes our primary hospital in the Texas Medical Center with expertise in over 40 pediatric subspecialties; the Jan and Dan Duncan Neurological Research Institute (NRI); the Feigin Center for pediatric research; Texas Children’s Pavilion for Women, a comprehensive obstetrics/gynecology facility focusing on high-risk births; Texas Children’s Hospital West Campus, a community hospital in suburban West Houston; and Texas Children’s Hospital The Woodlands, the first hospital devoted to children’s care for communities north of Houston. We have also created the nation’s first HMO for children, established the largest pediatric primary care network in the country and a global health program that is channeling care to children and women all over the world. Texas Children’s Hospital is also academically affiliated with Baylor College of Medicine, one of the largest, most diverse and successful pediatric programs in the nation.   To join our community of 14,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.   Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

Summary:

We are searching for a Pharmacy Financial Counselor of Specialty Pharmacy who has a working knowledge of pharmacy insurance claims adjudication.   In this position, you will be responsible for assisting with all electronically adjudicated specialty pharmacy claims, quality assurance functions on pharmacy claims, and organizing documents for insurance audits in order to minimize financial exposure.  This position will need an in-depth knowledge of pharmacy benefits management, including Medicaid and commercial third-party billing requirements for claims processing.  Finally, this role may be utilized as overflow coverage or during downtime situations for Specialty Pharmacy call center and dispensing operations.

 

Think you’ve got what it takes?



Responsibilities :

  • Perform insurance verification, determines primary, secondary, and tertiary payers and follows up on inpatient and outpatient accounts throughout the entire course of treatment
  • Meet with the family regarding their financial status to determine potential assistance for third party coverage in a timely and sensitive manner
  • Make every effort to minimize the loss of reimbursement for both inpatient and outpatient visits by securing coverage before discharge (unscheduled admissions) or during the patient’s visit
  • Maximize the efficiency and accuracy of the collection process on scheduled patients
  • Monitor and evaluate specific responsibilities of a Financial Counselor to identify key services and processes that have potential for improvement in outcomes, reducing the number of defects and increasing customer satisfaction
  • Provide required documentation in the patient’s chart, including signed forms such as general consent, information release, advanced care directives, and other documents required by JCAHO and other regulatory bodies, and obtains required signatures


Qualifications:

  • High school diploma or GED
  • A bachelor’s degree with an emphasis in business preferred
  • A minimum of 2 years’ related experience


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