Pharmacy Care Advocate, 1st shift
4 weeks ago
Works under the direction of the Pharmacy Manager. Independently acts as a liaison with patients/caregivers, physicians and other medical staff in identifying, facilitating, and ordering prescription medications via medication access programs for eligible patients who are underinsured. Also identifies opportunities from co-pay assistance foundations where available. Creates, manages and performs financial/billing/clinical audits to maintain the integrity of the programs and creates and distributes reports to pharmacy and hospital management concerning operations.
Is responsible for verifying accurate insurance and demographic information, obtaining or verifying prior authorization, referrals and communicating need for medical necessity for out-patient medication infusions.
Coordinates patient encounter utilizing multiple system applications, clinical operating systems, and communicating with appropriate team members to perform duties in a timely manner
Responsibilities:
1. Facilitates optimal drug therapy by serving as a patient advocate and as a liaison between patients, pharmaceutical companies, insurance providers, physicians, pharmacists, clinic staff and care coordination staff.
2. Assists in delivering high quality health care services in a professional, compassionate and courteous manner while respecting the dignity and individuality of each person who comes in contact with the organization by following the values of UMC.
3. Accurately attains patient history information upon receipt of prescription, including address, date of birth, phone number, drug allergies, disease states and third- party information.
4. Participates in the team approach to quality improvement to support the Pharmacy Department’s commitment to the philosophy and principles of Quality Patient Care.
5. Provides service to customers to meet or exceed their needs and expectations.
6. Shows evidence of independent work, promotes a cooperative work environment by utilizing communication skills which, in part, will include confirmation of teamwork and collaboration with other departments within the hospital through interpersonal relationships and team building.
7. Works cooperatively with others and organizes daily workflow to optimize output.
8. Shows evidence of independent work, promotes a cooperative work environment by utilizing communication skills which, in part, will include confirmation of teamwork and collaboration with other departments within the hospital through interpersonal relationships and team building.
9. Documents findings thoroughly and accurately.
10. Meets or exceeds productivity standards in the completion of daily assignments and accurate production.
11. Answers and responds to external and internal phone calls in a timely manner. Check and responds to emails in a timely and professional manner.
12. Complies with local, state and federal rules and regulations and accrediting bodies.
13. Completes all requested documentation of workload / reports for trending activities.
14. Attends and participates in department and hospital meetings, in-services, and quality improvement teams.
15. Contributes to the accomplishment of department and hospital objectives.
16. Projects a positive personal and professional image under all circumstances.
17. Performs other duties as assigned.
DRUG REPLACEMENT AND/OR CO-PAY ASSISTANCE:
18. Interviews patients and/or caregivers to obtain confidential qualifying information (demographics, financial and insurance information) necessary to complete applications for drug replacement and/or co-pay assistance programs.
19. Oversees the inventory management functionality of the program drugs in accordance with the regulations of pharmaceutical manufacturers and certifies patients in a timely manner so that benefits are uninterrupted.
20. Maintains accurate, up-to-date documentation of drug deliveries and reports of area serviced and volumes or tracking and trending.
21. Independently resolves majority of provider and customer concerns resulting in satisfactory outcomes – seeks assistance from a Pharmacist and/or Coordination Manager, as needed.
22. Contacts patients or caregivers by phone to determine medication/supply needs.
23. Works with physicians, nurses, pharmacists and Care Coordinators to better utilize formulary and drug benefit programs to maximize benefits for patients.
24. Performs financial/billing/clinical audits to ensure accurate information is processed and documented and communicates any discrepancies in a timely manner.
25. Seeks and maintains updated knowledge about Patient Assistance Programs and the skills needed to contribute to the education of others.
26. Manages all orders received by fax, physician EMR or other sources.
27. Identifies and shares information as appropriate to ensure patients obtain insurance coverage for the future.
28. Assists in obtaining drug replacement for pharmacy department related to accidental wastage.
PRIOR AUTHORIZATION & SCHEDULING:
29. Completes prior authorizations and appeals completely, accurately and promptly.
30. Contacts insurance plans/payors to determine eligibility and obtain coverage and benefit information relating to obtaining prior authorization.
31. Assists in the coordination of patient appointments, as necessary.
32. Independently resolves majority of provider and customer concerns resulting in satisfactory outcomes – seeks assistance from a Pharmacist, Medical Office and/or Coordination Manager, as needed.
33. Communicates in a timely manner to patient, provider, infusion/pharmacy staff, medical office staff to ensure patient is ready for treatment.
34. Maintains accurate, up-to-date documentation of area serviced and volumes or tracking and trending.
Qualifications:
Education / Accreditation / Licensure (required & preferred):
• High school/GED
• Registered or eligible to register as pharmacy technician with the State Board of Pharmacy Examiners.
Experience (required and preferred):
• One year experience as a pharmacy technician preferred OR
• One year experience with patient access, insurance verification, obtaining prior authorizations or medical billing experience preferred OR
• If working in a retail pharmacy setting and handling medications, PTCB certification will be preferred (time will be given to obtain such certification, if needed),
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