Pharmacy Access Rep III

University of Rochester; San Antonio (TX); On-site; USD 30,000 - 41,000; Full time

Job summary

The University of Rochester Pharmacy team is seeking a dedicated professional to coordinate medication access and support patients through insurance approvals. This role emphasizes prior authorizations and enrollment in patient assistance programs to ensure timely delivery of medications.

Responsibilities include cross-functional communication with prescribers, insurers, and patients, with a focus on minimizing treatment interruptions and optimizing patient outcomes.

Responsibilities

• Manage medication coordination and remove barriers to access.
• Submit prescriptions to insurance, including prior authorization.
• Enroll patients in PAPs and coordinate timely delivery.
• Coordinate communication among patient, provider, insurer, and staff.
• Ensure timely delivery and documentation; assist with audits and training.

Job description

Job Location (Full Address):

60 Corporate Woods, Brighton, New York, United States of America, 14623

Work Shift:

UR - Day (United States of America)

Compensation Range:

$21.97 - $29.66 The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job's compensation range, and will be determined by considering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations.

Responsibilities:

General Purpose: Manages medication coordination and removal of barriers that prevent patients from receiving their medications. Communicates with the prescriber's office to acquire necessary information to submit prescriptions to the patient's insurance for approval including prior authorization, and helps enroll patients in financial assistance programs and arrange timely delivery of the medication. Facilitates communication between the patient, pharmacist, insurance, and staff to ensure coordinated care.

Essential Functions:

Maintains expertise on all potential patient assistance programs (PAP), grants, foundations, and coupons relevant to the high-cost drugs prescribed in their assigned area(s). Analyzes patients that are receiving high-cost medications for potential participation in PAPs, and identifies the best options for the patient given their overall circumstances (insurance, disease state, income, etc). Coordinates with the patient and/or family to obtain necessary information, including income information and other personal details, as well as to present PAP options to the patient/family when there are multiple options. Enrolls patients in PAPs using the needed permission and information, follows up to determine the status of the application, and ensures proper documentation of this process. Submits all required documentation to the PAP throughout the duration of treatment to verify that payment for each prescription refill is still active. Understands and manages the payment process specific to each PAP, and ensures that payments are properly accounted for the correct patient and correct patient encounter. Meets or discusses with the patient and/or family the status of PAP eligibility on an as-needed basis if coverage changes during treatment duration. Serves as a subject matter expert available to patients, providers, and other staff about financial assistance resources, including PAPs, grants, foundations, manufacturer coupons, and social work. Collaborates with social services and case management on patient assistance. Coordinates medication and supplies preparation with pharmacy staff to ensure timely delivery. Troubleshoots insurance issues with pharmacists, physicians, and staff to prevent treatment interruptions. Follows up with patients to ensure safe and effective medication use. Documents problems with the medication (i.e. delivery issues, side effects, adherence, difficulty with administration, etc.) and triages issues to the pharmacist when appropriate. Coordinates medication ordering with inventory manager for special orders or low-volume medications. Tracks changes in prescribing trends and coordinates with inventory manager if changes in stock on hand is needed. Makes scheduled calls to patients to bill prescriptions and set up deliveries. Facilitates adherence to medications by ensuring that patients receive prescribed medications in a timely manner. Provides excellent customer service through the Pharmacy Call Center. Triages patient calls to the appropriate party. Answers incoming calls in a timely manner. Monitors and reconciles patient charge accounts once a month. Remains professional, courteous, and diligent in all interactions with staff and patients/families. Obtains high patient and provider satisfaction results. Reports errors through the hospital error reporting system (RL solutions) and contributes to quality improvement initiatives. Assists with prescription audits and ensures timely completion of required patient documentation. Assists with the training of new team members in the designated clinical area. Maintains expertise in the current policies of the most common payors for the relevant administered drugs that require prior authorization (PA), and will be responsible for working with the prior authorization coordinators, office staff nurses, and other patient care staff to ensure that all required elements of the policy are applicable in advance of requesting PA. Initiates, documents, and tracks all prior autho