Lead Specialty Pharmacy Patient Financial Advocate

Lead Specialty Pharmacy Patient Financial Advocate

The Specialty Pharmacy Patient Financial Advocate Lead assists the Specialty Pharmacy Patient Advocate Supervisor in supporting the Specialty Pharmacy Patient Advocate (PPA) team. This role is responsible for monitoring daily workload, developing and adjusting coverage along with addressing coverage for absenteeism. They will be first line support for PPAs to answer questions and provide guidance on patient concerns or complex benefits cases. In this role the lead will execute duties of the PPA approximately 75% of the time. This includes acting as a financial advocate for patients regarding access to their specialty or high-cost non-specialty prescription medications. These 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. The Pharmacy Patient Financial Advocate-Lead provides excellent customer service to communicate prescription costs and insurance requirements with patients, follows the enterprise financial clearance and financial assistance policy and procedures. In this role they are expected to maintain productivity, quality and customer service requirements according to department policy and procedure.

Responsibilities and Essential Job Functions

• Assists with monitoring daily workload and provides coverage plan recommendations to leadership team. Assists and guides staff with workload prioritization and redistribution.
• Monitor productivity and workload metrics for key activities.
• Complies with and assists with ensuring the team complies with specialty pharmacy accreditation, board of pharmacy and other applicable rules and regulations.
• Complete and/or triage ad hoc reporting and task management.
• Assists with initial and ongoing training of employees including cross-training to provide relief for absenteeism.
• Supports the Specialty Pharmacy Patient Financial Advocates (PPAs) for questions and answers, directing them to proper policies and procedures or resources.
• Support PPAs for guidance on patient concerns and complex benefits cases.
• Provides guidance through direction and role-modeling.
• Escalate recommendations for workflow changes to leadership.
• Execute duties of specialty pharmacy patient financial advocate through staffing up to approximately 75% of the time.
• 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.
• 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 as requested by leadership.
• 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
• Must be able to perform the professional, clinical and or technical competencies of the assigned unit or department as determined by leadership.
• Must be able to perform the professional, clinical and or technical competencies of the assigned unit or department.
• 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.

Required Education and Experience

• High School Graduate plus 3-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
• 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.

Required Language Skills

• Fluent English -

Knowledge Requirements

• Demonstrates strong oral and written communication skills.
• Ability to multi task, prioritize, and escalate.
• Demonstrated good oral and written skills.
• 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.
• Epic experience
• Customer service experience