UofL Health

Pharmacist

• The PCA works under the direction of the Pharmacy Manager or Supervisor.
• Serves as a liaison to patients/caregivers, physicians and other medical staff in identifying, facilitating, and ordering prescription medications via medication access programs for eligible patients who are underinsured.
• Identifies opportunities from co-pay assistance foundations where available.
• Creates, manages and performs financial/billing/clinical audits to maintain the integrity of the programs and creates and distributes reports to pharmacy and hospital management concerning operations.
• Responsible for verifying accurate insurance and demographic information, obtaining or verifying prior authorization, referrals, and communicating need for medical necessity for outpatient medication infusions.
• Coordinates patient encounters utilizing multiple system applications and communicates with appropriate team members to perform duties in a timely manner.

Pharmacy Care Advocate

• Works under the direction of the Pharmacy Manager or Supervisor
• Serves as a liaison to patients/caregivers, physicians, and other medical staff
• Identifies, facilitates, and orders prescription medications
• Manages and performs financial/billing/clinical audits
• Verifies accurate insurance and demographic information
• Coordinates patient encounters utilizing multiple system applications

Pharmacy Care Advocate – Specialty Pharmacy

Medical Billing and Coding

• Manage the appeal of unpaid claims in the Central Business Office
• Work closely with insurance carriers in resolving unpaid claims
• Review and appeal unpaid claims daily
• Completes follow-up work on appealed claims
• Works with insurance carriers on appeal issues
• Provides feedback to the coding department with coding errors or updates
• Review remit to ensure accurate payment was received
• Reviews denials for accuracy
• Obtains all necessary information to expedite the appeal process
• Closes and prints daily batch proof
• Makes charge corrections as needed in the practice management system
• Attends continued education programs for coding
• Other duties as assigned

Pharmacy Care Advocate

Pharmacy Care Advocate – Specialty Pharmacy

Certified Appeals Coder