POSITION SUMMARY

The team is seeking an individual knowledgeable about pharmacy and manufacturer assistance programs, insurance coverage (limitations, requirements, eligibility, formularies, prior authorizations, benefits investigations, etc.), available community and national resources, ICD-10 codes, and determinants of financial need. Additionally, this individual should display an understanding of pharmaceutical terminology (brand, generic, dose, route, etc.). The Patient Support Advocate (PSA) will work closely with pharmacy staff, clinic staff, and clinical pharmacist specialist to obtain the appropriate clinical and financial information for available assistance programs. Specialist are also responsible for providing patients and clinicians with accurate and up to date information regarding assistance programs, insurance eligibility, government subsidies, as well as maintaining a database with accurate patient and assistance program information. The PSA will work with the UH Home Care Pharmacy to make refill and other routine phone calls to patients and follow up on medication delivery.

This will be a 40-hour per week position that may have a rotating schedule based on operational needs. The position will work from the UH Home Care building in Warrensville Ohio.

POSITION SUMMARY

The team is seeking an individual knowledgeable about pharmacy and manufacturer assistance programs, insurance coverage (limitations, requirements, eligibility, formularies, prior authorizations, benefits investigations, etc.), available community and national resources, ICD-10 codes, and determinants of financial need. Additionally, this individual should display an understanding of pharmaceutical terminology (brand, generic, dose, route, etc.). The Patient Support Advocate (PSA) will work closely with pharmacy staff, clinic staff, and clinical pharmacist specialist to obtain the appropriate clinical and financial information for available assistance programs. Specialist are also responsible for providing patients and clinicians with accurate and up to date information regarding assistance programs, insurance eligibility, government subsidies, as well as maintaining a database with accurate patient and assistance program information. The PSA will work with the UH Home Care Pharmacy to make refill and other routine phone calls to patients and follow up on medication delivery.

This will be a 40-hour per week position that may have a rotating schedule based on operational needs. The position will work from the UH Home Care building in Warrensville Ohio.

ESSENTIAL DUTIES AND RESPONSIBILITIES

The responsibilities of the Patient Support Advocate include the following: UH Specialty Pharmacy Services

Medication Assistance (Access) Support

1. Process benefits investigations, prior authorizations, pre-certifications, and copayment assistance request for prescriptions received by the UH Home Care Specialty Pharmacy.

2. Maintain current knowledge of, requirements for and ability to enroll patients in: Pharmacy Assistance Program (PAP), manufacturer, state and local medication assistance programs; disease based assistance from non-profit organizations; Medicare prescription drug benefits; Social Security Low Income Subsidy; state and federal medication subsidy programs

3. Maintain documentation of patient status for resource programs in required databases

4. Evaluate all self-pay and underinsured patients for PAP/MAP eligibility and enroll patients based on financial need

5. Work collaboratively with clinical based pharmacist to obtain clinical and financial information needed for program enrollment

6. Utilize internally developed systems, commercial vendor software (to track patient eligibility, prescriptions, patient communications and program enrollment), outpatient clinical, scheduling and financial systems as necessary

7. Interact with physicians, nurses, and other health care professionals in a courteous and professional manner

8. Display the highest level of customer service, attentiveness, and consideration possible in all situations

9. Support all new team initiatives

10. Elevate issues promptly to supervisors to promote positive outcomes for internal and external customers

11. Maintain organized workspace to help foster efficient operations

12. Show attention to detail, accuracy, and thoroughness in an effort to continually improve quality

13. Manage time wisely and demonstrate the ability to prioritize assigned tasks

Telepharmacy Support

1. Answer incoming calls and respond to electronic communications

2. Assist health care providers and patients by greeting them by phone; answering questions and requests; referring inquiries to the site pharmacist(s) as needed.

3. Handle customer inquiries both telephonically and by email

4. Research required information using available resources

5. Manage and resolve customer complaints

Qualifications - External

Three to five years’ experience in a pharmacy, multi-system hospital, or physician practice setting

Excellent organizational, analytical and problem solving skills required.

Strong oral and written communication abilities

Working knowledge of the complexities and interdependencies of Insurance Benefits, Medical Records, and pharmacy operations.

Strong technical skills and abilities in planning, solution structure, assessment, analysis, client relationship management.

Bachelor’s degree preferred

 CPhT certification preferred