Specialty Pharmacy Patient Financial Advocate PRN Hybrid

The University of Kansas Health System•Southlake, TX

27d•Hybrid

About The Position

The Specialty Pharmacy Patient Financial Advocate helps patients access specialty prescription medications used to treat serious or life-threatening and rare diseases. The role supports patients through complex insurance requirements and the high costs associated with these therapies by obtaining insurance authorization, identifying copay assistance, and applying for manufacturer-provided free medication when other options are unavailable. The advocate communicates prescription costs and insurance requirements to patients and follows enterprise financial clearance and financial assistance policies and procedures. The role maintains department productivity, quality, and customer service standards.

Requirements

High school diploma or equivalent and 3 years of experience in specialty pharmacy, medication assistance, prior authorizations, pharmacy benefits investigation, managed care, financial advising, claims processing, collections, or revenue cycle positions; alternatively, an associate degree in a related field from an accredited college or university and 1 year of such experience.
Ability to type 45 words per minute.
Kansas Pharmacy Technician registration within 60 days of hire; registration includes an application with the state board of pharmacy.
Strong oral and written communication skills.
Ability to multitask, prioritize, and escalate issues.
Knowledge of commercial and government insurance.
Ability to navigate payer websites.
Working knowledge of CMS regulations applicable to Medicare Part B and Part D plans.
Customer service experience.
Epic experience.

Nice To Haves

At least 1 year of experience using Microsoft Word, Excel, or a related computer program.

Responsibilities

Gather patient information and complete specialty prescription benefits investigations within required time frames.
Interpret, comply with, and communicate Medicare and Medicaid rules and regulations when applicable.
Ensure specialty medications are billed appropriately, including completing required insurance authorizations using medical record information.
Follow up with insurance companies on denials and inquiries, provide additional documentation, and resolve accounts within required time frames.
Identify and apply for copay assistance on behalf of patients when possible; review financial documents, coordinate application materials, and follow up with assistance foundations.
For uninsured or underinsured patients without other assistance options, identify and apply to manufacturer free-drug programs, review financial documents, coordinate application materials, and follow up on applications.
Communicate payer trends to management.
Document activities in the electronic medical record according to department policy.
Contact patients or caregivers by phone or electronically to clarify prescription coverage and financial information, explain delays, and identify needed information or actions.
Use critical thinking to solve problems and escalate issues to leadership when appropriate.
Communicate with pharmacists and clinic staff to resolve insurance or other issues that delay prescriptions.
Respond to and resolve patient billing questions and complaints with compassion, courtesy, professionalism, and timeliness.
Take action to resolve account issues, including denials, insurance changes, claim refiling, contacting insurers, and answering questions.
Identify and participate in continuous improvement opportunities and assist with departmental planning and process improvements.
Communicate effectively with patients and insurance companies about sensitive financial matters.
Assist with training new team members when requested by leadership.
Process patient and insurance statements, payments, refunds, and adjustments through the point-of-sale system when necessary.
Review and analyze monthly reports, data, and trends; identify improvement opportunities and communicate findings to leadership.
Perform the professional, clinical, or technical competencies of the assigned unit or department; other duties may be assigned.