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Healthcare Support Specialist

2 months ago

Chardon, Ohio, United States University Hospitals Full time
Sign-on Bonus: $2,500

Preferred Qualifications:

Licensure: Registered Pharmacy Technician with Board of Pharmacy highly preferred.

Position Overview:

The Patient Support Advocate is well-versed in pharmacy and manufacturer assistance initiatives, insurance coverage intricacies (including limitations, requirements, eligibility, formularies, prior authorizations, and benefits investigations), and available community and national resources. This role requires familiarity with ICD-9 codes and factors influencing financial need. The Patient Support Advocate (PSA) collaborates closely with pharmacy personnel, clinic teams, and clinical pharmacist specialists to gather essential clinical and financial information for available assistance programs. Additionally, the PSA is tasked with delivering accurate and current information to patients and healthcare providers regarding assistance programs, insurance eligibility, and government subsidies, while also maintaining a comprehensive database of patient and assistance program details. The PSA will coordinate with the Pharmacy Services to manage refill requests and follow up on medication deliveries.

Key Responsibilities:
  • Call Center Operations:

    • Respond to incoming calls and electronic communications.

    • Assist healthcare providers and patients by providing information over the phone; addressing inquiries and directing them to pharmacists as necessary.

    • Handle customer inquiries via phone and email.

    • Research and provide required information using available resources.

    • Resolve customer complaints effectively.
  • Medication Access Support:

    • Process benefits investigations, prior authorizations, pre-certifications, and copayment assistance requests for prescriptions received by the pharmacy.

    • Stay informed about requirements for enrolling patients in various assistance programs, including Pharmacy Assistance Programs (PAP), manufacturer programs, and state/local medication assistance initiatives.

    • Document patient status for resource programs in necessary databases.

    • Assess self-pay and underinsured patients for eligibility and enroll them based on financial need.

    • Collaborate with clinical pharmacists to obtain required clinical and financial information for program enrollment.

    • Utilize developed systems and commercial software to track patient eligibility, prescriptions, and communications.
  • Provide exceptional customer service and maintain a professional demeanor in all interactions.
  • Support new initiatives within the team.
  • Promptly escalate issues to supervisors to ensure positive outcomes for both internal and external customers.
General Requirements:
  • Perform additional duties as assigned.
  • Adhere to all organizational policies and standards.
  • For specific responsibilities, refer to documentation provided during orientation.
  • Comply with all regulations regarding the secure handling of Protected Health Information (PHI).
Qualifications:
Education:
  • Bachelor's Degree preferred.
Knowledge, Skills, & Abilities:
  • Strong organizational, analytical, and problem-solving skills.
  • Excellent oral and written communication skills.
  • Understanding of the complexities of Insurance Benefits, Medical Records, and pharmacy operations.
  • Proficient technical skills in planning, assessment, and client relationship management.
  • Maintain an organized workspace to enhance operational efficiency.
  • Attention to detail and commitment to quality improvement.
  • Effective time management and task prioritization skills.
Licenses and Certifications:
  • Registered Pharmacy Technician (RPhT) preferred.
Physical Demands:
  • Occasional standing and walking.
  • Constant sitting.
  • Rarely lifting or carrying up to 20 lbs.
  • Frequent repetitive motions and eye/hand/foot coordination.