Specialty Pharmacy Patient Financial Advocate PRN Hybrid

The University of Kansas Health System; Lenexa (KS); Hybrid; USD 45.000 - 65.000; Vollzeit

Benefits dieser Stelle

Tuition Reimbursement

Wellness Program

Employee Assistance Program (EAP)

401(a) Retirement Plan

Zusammenfassung

The University of Kansas Health System is seeking a Specialty Pharmacy Patient Financial Advocate to act as a financial advocate for patients needing specialty medications. The role involves securing insurance authorizations, pursuing copay assistance, and applying manufacturer programs for uninsured patients, while maintaining accurate documentation.

You will interact with patients, pharmacists, and clinic staff to resolve coverage issues and ensure timely access to medications within a hybrid,

Qualifikationen

• 3 years of experience in specialty pharmacy, medication assistance, prior authorizations or related roles.
• Associates Degree plus 1 year in specialty pharmacy or revenue cycle positions.
• Typing speed of 45 words per minute.

Aufgaben

• Act as a financial advocate for patients regarding access to specialty medications.
• Secure insurance authorization and explore copay assistance options.
• Coordinate with manufacturer programs for free drugs for uninsured patients.
• Communicate prescription costs and insurance requirements to patients.
• Follow enterprise financial clearance and assist with financial policies.
• Document activities in the electronic medical record per policy.

Kenntnisse

Communication skills

Medical insurance knowledge

Customer service

Microsoft Word/Excel

Typing speed 45 wpm

CMS regulations knowledge

Ausbildung

High School Diploma

Associates Degree

Tools

Epic

Microsoft Word

Microsoft Excel

Jobbeschreibung

Specialty Pharmacy Patient Financial Advocate PRN Hybrid

Our nurses are leaders and decision makers, working closely with physicians to provide the best care and most advanced treatments. On our team, you’ll work in an environment of respect and professionalism, and you’ll have the support to advance your nursing career in the direction you choose. Find out more about the wide variety of opportunities for nurses at The University of Kansas Health System.

Responsibilities

Job Summary

Job ID: R-58756 Site Location: Southlake Campus

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 disease (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. Follows the enterprise financial clearance and financial assistance policy and procedures. Maintains productivity, quality and customer service requirements according to department policy and procedure.

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. 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.
• 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. 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 escape 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.
• 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
• Process statements, payments, refunds and adjustments to patients and insurance companies through point-of-sale system, when necessary.
• Review and analyze monthly reports, data and trends for improvement opportunities and communicate to 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-yearof 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 Licensure and Certification

• Kansas Pharmacy Technician within 60 days of hire (Registration includes application with state board of pharmacy).

Knowledge Requirements

• Demonstrates strong oral and written communication skills.
• Ability to multi task, prioritize, and escape.
• 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

We are an equal employment opportunity employer without regard to a person’s race, color, religion, sex (including pregnancy, gender identity and sexual orientation), national origin, ancestry, age (40 or older), disability, veteran status or genetic information.

The main reason I love coming to work is because of the amazing team. We promote a nursing culture that encourages kindness and teamwork, and I absolutely love that about our hospital. – Riley Ferree, RN

Our robust medical, dental and vision package allows you to choose options that are best for your family. We offer life, disability, and accident insurance plus voluntary offerings such as critical illness insurance and identity theft protection.

• Medical, dental and vision package
• Life, disability, and accident insurance plus voluntary offerings such as critical illness insurance and identity theft protection

Giving back

In addition to the quality healthcare we provide, we have opportunities to serve externally in our community in activities throughout the year.

Team-based culture

At the health system, we are a team. If you are highly skilled and motivated but don’t want to work in an “everyone for themselves” culture like many academic institutions have, this is your place.

Support and Resources

We have a comprehensive wellness program with resources to support your physical, mental, and emotional health. Our new Employee Assistance Program (EAP) includes free counseling sessions and legal advice options.

Tuition Reimbursement

We offer tuition reimbursement for formal education credits.

401(a)

We offer a retirement savings plan with an employer contribute.

Success Profile

What makes a successful Nurse at The University of Kansas Health System? Review the traits we’re looking for and see if you have the right combination.

• Acccountable to Team
• Takes Initiative
• Possesses Integrity
• Desire to Grow & Development

Our Culture

• Work with a team that supports you, in a place where you will feel you belong and will make a difference. We empower staff to put the patient first in all things – even beyond clinical care. We value people.
• Driven to serve: Every employee makes an impact, regardless of your role – no matter if you’re in scheduling, facilities or clinical staff. We know that each step of the process ultimately impacts the patient.
• Our leadership is approachable, open-minded, and adaptable to challenges in healthcare.
• We demonstrate values proudly and consistently. Values such as diversity and inclusion are important to our staff; there is a desire to see this reflected by the health system internally and externally.
• Even though we are a large organization, our employees feel the health system’s resources, culture and commitment to quality allow them to provide exceptional care for patients.
• Our health system welcomes patients and cases that other hospitals cannot. This represents our commitment to care and our passion to challenge ourselves and be the best.
• We are a true healthcare leader in the region, rooted in experience and excellence.
• We offer unique opportunities for professional development, as well as convenient pathways for onsite continuing education among healthcare professionals and staff – from GED to CEUs.
• We make a difference in our communities by improving the health and lives of our patients.
• We also support our communities through Health System Employees Reaching Out events.