Pharmacy assistance access, coordination and referral.
Accepts, reviews, approves or denies applications for all pharmacy assistance programs.
- Determines on-going enrollment for programs.
Researches and assigns the correct codes and enters into the computer system.
Conducts audits on submitted applications based on random audit criteria to confirm the accuracy of the information submitted through the application process.
- Resolves prescription drug plan payment and eligibility issues.
Explains payment and eligibility decisions to clients and in administrative reviews and/or fair hearings as necessary.
Refers individuals, as appropriate, to other pharmacy assistance programs offered through the State or other entities.
Conducts annual redeterminations of eligibility for the pharmacy assistance programs for each individual enrolled.
Maintains case records to include changes in household, circumstances and application
of program policies, including basis for eligibility decision.
- Identifies allegations of program abuse or fraud.
Establishes and maintains a cooperative working environment with resource agencies.
Coordinates and communicates with pharmacists on client pharmacy coverage.
Coordinates with health insurance resources to find the prescription drug plan that best fits client's needs and is affordable with help from the division’s programs.
Conducts special projects as assigned.
Physical and Environmental Demands: Typical office environment with keyboarding requirements.
Required for the first day of work:
Knowledge of social services, health care delivery, reimbursement systems, and/or eligibility and enrollment systems.
Attention to detail and accuracy.
Ability to work in an organized and efficient manner and meet dea dlines.Ability to work as a team member in sharing workload.
Ability to provide eligibility decision information in an easily understood manner, especially for the senior population.
Ability to research and analyze information.
Ability to operate a personal computer and general office equipment as necessary to complete essential functions, including using spreadsheet, word processing, database, email, internet, and other computer programs.
Six months of experience working with acommunity-based and/or statewide assistance program and its eligibilityrequirements.
Minimum Qualifications (Required Education and Experience):
Bachelor’s degree in human services, business, education, public/health administration or related field.
One year of job-related work experience with duties that include analysis and decision making and/or solving client service problems.
Other combinations of directly-related education and experience may be considered on a case-by-case basis.
If another department vacancy occurs in this job title within six months, the same applicant pool may be used for the selection.
This agency may use a training assignment. Employees in training assignments may be paid below the base pay established by the agency pay rules. Conditions of the training assignment will be stated in writing at the time of hire.