Specialty Pharmacy Patient Financial Advocate

Position Summary / Career Interest:

The Specialty Pharmacy Patient Financial Advocate is responsible for acting as a financial advocate for patients regarding access to their specialty prescription medications. Specialty medications include prescription medications that are typically used to treat serious and often life threatening disease (cancer, hepatitis C, rheumatoid arthritis, HIV/AIDS, multiple sclerosis, cystic fibrosis, etc.) or rare diseases. These medications are complex and may require additional monitoring, have special administration, storage, and delivery requirements. Access to these medications can be made more complex through strict insurance requirements and the high cost of these therapies. Specialty Pharmacy Patient Financial Advocate job responsibilities include, but are not limited to, securing authorization for the medication through the patient’s prescription insurance, seeking copay assistance options for the patient, seeking free drug from manufacturer programs for uninsured and underinsured patients. Provides excellent customer service to communicate prescription costs and insurance requirements with patients. Follows the enterprise financial clearance and financial assistance policy and procedures. Maintains productivity, quality and customer service requirements according to department policy and procedure.

Responsibilities:

• Must be able to perform the professional, clinical and or technical competencies of the assigned unit or department.
• Note:  These statements are intended to describe the essential functions of the job and are not intended to be an exhaustive list of all responsibilities.  Skills and duties may vary dependent upon your department or unit.  Other duties may be assigned as required.
• Effectively gathers patient information to complete a specialty prescription benefits investigation within a specified time frame.
• Interpret, comply, and communicate Medicare/Medicaid rules and regulations, when appropriate.
• Ensures appropriate billing of all specialty prescription medications including the completion of any required insurance authorizations using information in the medical record to satisfy the insurance requirements

Follows up with insurance companies on denials and insurance inquiries as necessary to resolve the account within a specified time frame.

Provides additional information or documentation as needed to resolve account.

• Seeks out copay assistance for specialty prescriptions and applies on behalf of the patient when possible.  Requires review of patient’s financial documents and coordination of necessary application materials, as appropriate.

Follows up with copay assistance foundations to ensure applications are reviewed and processed in a timely manner.  Provides any additional information as necessary to resolve the account within a specified time frame.

Communicates payer trends to management.

• For uninsured and underinsured patients with no other copay assistance options, seeks out free drug from available manufacturer programs and applies on behalf of the patient. Requires review of patient’s financial documents and coordination of necessary application materials, as appropriate.

Follows up with manufacturer programs to ensure applications are received and being processed

• Documents all activities within the electronic medical record per department policy.
• Proactively contacts the patient or family by phone or electronically (email, electronic health record) to ask questions about prescription coverage and financial information (when needed). When delays occur, ensures patient or patient’s caregiver understands the reason for delay and what information or actions are needed to fill the prescription.
• Uses critical thinking skills to effectively solve problems. Understands when to escalate issues to leadership.
• Communicates effectively with pharmacists and clinic staff to discuss and address any insurance issues or other issues requiring resolution that prevent a patient from receiving their prescription in a timely manner.
• Receives and resolves patient billing questions and complaints in a compassionate, courteous, professional, and timely manner.
• Takes actions to resolve issues such as denials, changing insurance, re-filing claims, calling insurance companies or answering questions.
• Identifies and participates in continuous improvement opportunities and assists with implementing departmental planning and process improvements.
• Demonstrates the ability to effectively communicate with patients and insurance companies regarding sensitive financial matters.
• Assists with training of new team members as requested by leadership
• Process statements, payments, refunds and adjustments to patients and insurance companies through point-of-sale system, when necessary.
• Review and analyze monthly reports, data and trends for improvement opportunities and communicate to leadership

Required

• High school diploma or GED
• Effective 1/1/2023: Associate degree and 1 year of experience in specialty pharmacy, medication assistance, prior authorizations, pharmacy benefits investigation, managed care, financial advising, claims processing, collections, or revenue cycle positions
• OR
• 3 years of experience in specialty pharmacy, medication assistance, prior authorizations, pharmacy benefits investigation, managed care, financial advising, claims processing, collections, or revenue cycle positions
• Kansas Pharmacy Technician within 60 days of hire (Registration includes application with state board of pharmacy)
• Demonstrates strong oral and written communication skills
• English
• Ability to multi task, prioritize, and escalate
• Demonstrated good oral and written skills
• Typing (45 wpm)
• Basic computer skills

Preferred

• Bachelor’s degree
• Epic experience
• Customer service experience
• Knowledge of Insurance (Commercial & Government)
• Knowledge of how to navigate payor websites
• Working knowledge of CMS regulations as applicable to Medicare Part B and D plans
• Microsoft (Word and Excel)

We are an equal employment opportunity employer without regard to a person’s race, color, religion, sex (including pregnancy, gender identity and sexual orientation), national origin, ancestry, age (40 or older), disability, veteran status or genetic information.