Ardon Health specialty pharmacy services

Ardon Health

Lead of Prescription Processing

Job Title
Lead of Prescription Processing
Job ID
27688954
Location
Portland,  OR 97220
Other Location
Description
Join our team!
As we continue to grow, we are seeking a Lead of Prescription Processing to join our award-winning specialty pharmacy team. 

About Ardon Health
At Ardon, we are passionate about our mission to inspire people and improve lives through the delivery of high-quality, compassionate healthcare services. We are patient-centric and maintain an innovative, collaborative, and positive work environment. We are committed to cultivating talent and fostering growth within our organization. Ardon Health is proud to have been recognized as a Top Workplace by the Oregonian in 2021. 
Our beautiful office is located near the airport in Northeast Portland.  Visit ardonhealth.com to take a virtual tour and learn more!

What is Specialty Pharmacy? 
Specialty pharmacies handle medications not typically found in retail pharmacies.  These medications are often used to treat complex or rare conditions. Ardon Health provides services designed to enhance patient care and provide tailored assistance to all patients on their treatment journey.

Major purpose:
The Lead of Prescription Processing provides leadership and support to processes related to billing, insurance, and referral management and corresponding teams. This position acts as a liaison for pharmacists, providers, and staff for escalated needs. The Lead of Prescription Processing will direct team resources to ensure timely completion of work and appropriate follow through with tasks. This position assists corresponding departments with troubleshooting issues, investigating solutions, and addressing escalated inquiries.  Responsibilities also include ensuring department quality and assisting with process and workflow revision as necessary.

Mission:  To inspire people and improve lives through the delivery of high-quality, compassionate healthcare services.

Every position at Ardon has a direct impact on Ardon’s ability to deliver on its mission. Each team member has the responsibility to support the company’s quality program activities to ensure quality remains the centerpiece of Ardon’s operations.  


Benefits:
  • Competitive pay
  • Flexible PTO and paid company holidays
  • Medical, dental, vision, disability, and life insurance 
  • 401K match

Pay Range: $28.39 to $35.49 per hour (depending on experience)

Position specifications:
  1. Education and experience
    1. Required:
      1. High school diploma or GED. 
      2. Active Oregon Pharmacy Technician or Oregon Certified Pharmacy Technician License. If Oregon Pharmacy Technician, will be required to obtain Oregon Certified Pharmacy Technician License within six months of date of hire or prior to Pharmacy Technician license expiring.
    2. Preferred:
      1. Successfully meets all essential functions of Billing and Insurance level I and level II positions and/or Referral Resource Specialist level I and II positions and/or equivalent experience.
      2. Prior work experience in a customer service setting.
      3. Minimum 2 years’ work experience in a pharmacy setting.
      4. Work experience in a specialty pharmacy setting.
  2. Physical and mental functions and activities
    1. Must be able to be innovative, solution-oriented and to strive for best practices.
    2. Must be able to shift direction based on business needs while successfully remaining focused.
    3. Must demonstrate excellent customer service skills and the ability to express compassion and empathy.
    4. Must be able to multi-task and work in a fast-paced environment.
    5. Must demonstrate teamwork and a positive outlook.
    6. Must have excellent verbal, written, and interpersonal communication skills.
    7. Must be able to express oneself, detect, perceive, observe, and assess information exchanged in a variety of communication methods.
    8. Must be able to demonstrate proficiency with computer applications.
    9. Must be able to work independently as well as part of a team.
    10. Must be able to provide timely, accurate, courteous, and concise responses to escalated inquiries in person, by telephone, or by correspondence.
    11. Must have strong knowledge of prescription intake requirements, insurance plans, and patient assistance programs with the ability to assist patients to coordinate insurance benefits and/or explore options for copay and other financial assistance.
    12. Must be able to manage and support special projects as assigned.
    13. Must be able to manage escalated issues that occur within pharmacy software system work queues.
    14. Must be able to understand and interpret claims adjudication issues with Pharmacy Benefit Management organizations, insurance plans, and Patient Assistance Programs.
    15. Must be able to accurately utilize applicable computer software and equipment for pharmacy claims processing.
  3. Working conditions
  1. Work is performed in an office environment, with extensive keyboard and telephone work in stationary position.
  2. Business needs may occasionally require work in excess of 40 hours per week, including work outside of standard work week.
  1. Contact with others:
  1. Internally with Ardon employees across multiple departments.
  2. Externally with patients, prescribers, prescriber agents, clients, third-party payers, HUBs, and manufacturers.

Essential functions and activities:
  1. Provides day-to-day leadership, guidance, and direct support to the Billing and Resource Teams to successfully achieve patient service goals and meet individual patient needs.
  2. Plans, prepares, and devises work schedules according to budget and workload. 
  3. Trains, coaches, and motivates staff for the successful performance of the department and achievement of company objectives.
  4. Monitors staff members’ performance and schedules according to departmental standards.  Provides effective two-way feedback to motivate high performance and a productive environment.
  5. Assists with development, monitoring, and response to department and employee reports for quality, service levels, productivity, and other markers.  Monitors and measures against markers.
  6. When directed, communicates items of potential operational impact to leadership as appropriate.  Coordinates responses to escalated payer inquiries and communicates escalated patient needs to payers, with guidance from operational leadership.
  7. Responsible for application tasks, including but not limited to:
  1. Processing incoming documents
  2. Maintaining patient records
  3. Loading insurance information
  4. Performing prescription data entry
  5. Processing prior authorization notices
  6. Performing and reviewing claim submission and reversal
  7. Addressing billing exceptions
  8. Support accounts receivable processing needs
  1. Reports any identified obstacles or improvements to workflow to operational leadership.
  2. Troubleshoots adjudication issues and is well versed in the nuances of insurance billing and benefits investigation.
  3. Fields multi-department email requests and addresses issues or facilitates routing to alternate department.
  4. Supports creation and revision of team process documents.
  5. Supports call center when business needs arise.
  6. Interacts with all areas of Ardon Health to correct or enhance specific implementation activities as identified through customer service issues (billing, coordination of benefits, payment processing), observation, and communication with patients or group contacts.
  7. Assists manager with testing new processes, developing training and operational materials, and writing business requirement documents. 
  8. Maintains active Oregon license. Informs supervisor within 1 business day (and Oregon Board of Pharmacy within 10 days) of any arrests, convictions, suspected or known violations of law, or any other conduct that might affect or has affected license status. Reports to Oregon Board of Pharmacy within 15 days any changes to name, residence address, or employment.
  9. Actively participates and provides support as needed to leadership and quality program staff to ensure activities related to the company’s quality management program and quality improvement activities maintain priority focus and are effectively executed. This may include but is not limited to activities that promote objective and systematic measurement, monitoring, and evaluation of services and defined Quality Improvement Projects (QIPs) that may result from such efforts.
  10. Complies with the company’s Human Resources policies, Employee Handbook, Code of Conduct, and all department policies and procedures, including protecting confidential company, employee, and customer information; attending work punctually and regularly; and adhering to good safety practices in all activities.
  11. Performs other duties and responsibilities as assigned.

Ardon Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual identification or orientation, national origin, marital status, disability, veteran status, or any other status protected by law. Offers of employment are conditional upon proof of COVID-19 vaccination.
 
Pay Range
$28.39   Hourly to $35.49   Hourly

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