Specialty Pharmacy Patient Financial Counselor

Specialty Pharmacy Patient Financial Counselor

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 prescription medications that are typically 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. Specialty Pharmacy Patient Financial Advocate job 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.

Provides excellent customer service to communicate prescription costs and insurance requirements with patients.

Responsibilities and Essential Job Functions

• Effectively gathers 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.
• Ensures 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.
• 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.
• Follows up with copay assistance foundations to ensure applications are reviewed and processed in a timely manner.
• Communicates payer trends to management.
• 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.
• 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 to ask questions about prescription coverage and financial information.
• Uses critical thinking skills to effectively solve problems.
• Communicates effectively with pharmacists and clinic staff to discuss and address any insurance issues or other issues requiring resolution.
• 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.
• 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.
• Processes statements, payments, refunds, and adjustments to patients and insurance companies through point-of-sale system, when necessary.
• Reviews and analyzes monthly reports, data, and trends for improvement opportunities and communicates to leadership.

Required Education and Experience

• Associate's Degree in a related field of study from an accredited college or university, and 1 or more 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, 3 or more years of experience in specialty pharmacy, medication assistance, prior authorizations,…