PRN Specialty Pharmacy Patient Financial Advocate - Hybrid

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 those used to treat serious and often life-threatening diseases (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.

Responsibilities

• Effectively gather 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.
• Ensure 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.
• Follow up with insurance companies on denials and insurance inquiries as necessary to resolve the account within a specified time frame.
• Solicit copay assistance for specialty prescriptions and apply on behalf of the patient when possible.
• Review and coordinate necessary application materials for copay assistance.
• Follow up with copay assistance foundations to ensure applications are reviewed and processed in a timely manner.
• Seek out free drugs from manufacturer programs for uninsured and underinsured patients and apply on behalf of the patient.
• Document all activities within the electronic medical record per department policy.
• Proactively contact the patient or family by phone or electronically (email, electronic health record) to ask questions about prescription coverage and financial information (when needed).
• Identify and participate in continuous improvement opportunities and assist with implementing departmental planning and process improvements.
• Demonstrate the ability to effectively communicate with patients and insurance companies regarding sensitive financial matters.
• Absorb and resolve patient billing questions and complaints in a compassionate, courteous, professional, and timely manner.
• Take actions to resolve issues such as denials, changing insurance, re-filing claims, calling insurance companies or answering questions.
• Assist 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.

Skills and duties

• Strong oral and written communication skills.
• Ability to multi-task, prioritize, and escalate.
• Good oral and written skills.
• Knowledge of Insurance (Commercial & Government).
• Working knowledge of CMS regulations as applicable to Medicare Part B and D plans.
• Epic experience.
• Customer service experience.

Required Education And Experience

• High School Graduate plus 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.
• OR Associates Degree in a related field of study from an accredited college or university plus 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.
• Must be able to type 45 wpm.

Preferred Education And Experience

• 1 or more years of experience using Microsoft Word, Excel or a related computer program.