[Hiring] Pharmacy Care Advocate @UofL Health

Role Description

The PCA works under the direction of the Pharmacy Manager or Supervisor. The PCA serves as a liaison to patients/caregivers, physicians, and other medical staff in identifying, facilitating, and ordering prescription medications via medication access programs for eligible patients who are underinsured. They also identify opportunities from co-pay assistance foundations, where available. They will create, manage, and perform financial/billing/clinical audits to maintain the integrity of the programs and create and distribute reports to pharmacy and hospital management concerning operations.

The PCA is responsible for verifying accurate insurance and demographic information, obtaining or verifying prior authorization, referrals, and communicating the need for medical necessity for out-patient medication infusions. They also coordinate patient encounters utilizing multiple system applications, clinical operating systems, and communicating with appropriate team members to perform duties in a timely manner.

Essential Functions

• 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.
• Assists in delivering high-quality health care services in a professional, compassionate, and courteous manner while respecting the dignity and individuality of each person.
• Accurately obtains patient history information upon receipt of prescription, including address, date of birth, phone number, drug allergies, disease states, and third-party information.
• Works cooperatively with others and organizes daily workflow to optimize output.
• Documents findings thoroughly and accurately.
• Meets or exceeds productivity standards in the completion of daily assignments and accurate production.
• Answers and responds to external and internal phone calls in a timely manner; checks and responds to emails in a timely and professional manner.
• Completes all requested documentation of workload/reports for trending activities.

Assists with Drug Replacement and/or Co-Pay Assistance

• Interviews patients and/or caregivers to obtain confidential qualifying information necessary to complete applications for drug replacement and/or co-pay assistance programs.
• Oversees the inventory management functionality of the program drugs in accordance with the regulations of pharmaceutical manufacturers.
• Maintains accurate, up-to-date documentation of drug deliveries and reports of area serviced and volumes or tracking and trending.
• Independently resolves the majority of provider and customer concerns resulting in satisfactory outcomes.
• Contacts patients or caregivers by phone to determine medication/supply needs.
• Works with physicians, nurses, pharmacists, and Care Coordinators to better utilize formulary and drug benefit programs.
• Performs financial/billing/clinical audits to ensure accurate information is processed and documented.
• Seeks and maintains updated knowledge about Patient Assistance Programs.
• Manages all orders received by fax, physician EMR, or other sources.
• Identifies and shares information as appropriate to ensure patients obtain insurance coverage for the future.
• Assists in obtaining drug replacement for pharmacy department related to accidental wastage.

Assists with Prior Authorization & Scheduling

• Completes prior authorizations and appeals completely, accurately, and promptly.
• Contacts insurance plans/payors to determine eligibility and obtain coverage and benefit information.
• Assists in the coordination of patient appointments, as necessary.
• Independently resolves the majority of provider and customer concerns resulting in satisfactory outcomes.
• Communicates in a timely manner to patient, provider, infusion/pharmacy staff, medical office staff to ensure patient is ready for treatment.
• Maintains accurate, up-to-date documentation of area serviced and volumes or tracking and trending.

Other Functions

• Participates in the team approach to quality improvement to support the Pharmacy Department’s commitment to the philosophy and principles of Quality Patient Care.
• Attends and participates in department and hospital meetings, in-services, and quality improvement teams.
• Contributes to the accomplishment of department and hospital objectives.
• Maintains compliance with all company policies, procedures, and standards of conduct.
• Complies with HIPAA privacy and security requirements to maintain confidentiality at all times.
• Performs other duties as assigned.

Qualifications

• High School or GED/equivalent (required).
• Three (3) years of experience as a pharmacy technician (preferred).
• Three (3) years of experience with patient access, insurance verification, obtaining prior authorizations, or medical billing experience (preferred).

Licensure

• Registered or eligible to register as pharmacy technician with the State Board of Pharmacy Examiners (required).

Certification

• 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).