Specialty Pharmacy Patient Financial Counselor - Hybrid

Overview

Position Title:

Specialty Pharmacy Patient Financial Counselor - Hybrid Southlake Campus. This is a full-time position, Monday - Friday days with no weekend commitment. A two-day hybrid work schedule option is available after initial training is complete. The role can also accommodate 100% onsite if that is preferred.

The Specialty Pharmacy Patient Financial Counselor is responsible for acting as a financial advocate for patients regarding access to their specialty prescription medications. Specialty medications are typically used to treat serious and often life-threatening diseases and may have complex administration, storage, and delivery requirements. Access can be made more complex by strict insurance requirements and high costs. Responsibilities include securing authorization for medications through patient insurance, seeking copay assistance or manufacturer programs for uninsured/underinsured patients, and communicating prescription costs and insurance requirements to patients.

The role follows enterprise financial clearance and financial assistance policies and maintains productivity, quality, and customer service per department policy.

• 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.
• Ensure appropriate billing of all specialty prescription medications including completion of required insurance authorizations using information in the medical record to satisfy insurance requirements.
• Follow up with insurance companies on denials and inquiries as necessary to resolve the account within a specified time frame.
• Provide additional information or documentation as needed to resolve the account.
• Seek out copay assistance for specialty prescriptions and apply on behalf of the patient when possible. Review of patient financial documents and coordination of necessary application materials, as appropriate.
• Follow up with copay assistance foundations to ensure applications are reviewed and processed in a timely manner. Provide any additional information as necessary to resolve the account within a specified time frame.
• Communicate payer trends to management.
• For uninsured and underinsured patients with no other copay assistance options, seek out free drug from available manufacturer programs and apply on behalf of the patient. Review of patient financial documents and coordination of necessary application materials, as appropriate.
• Follow up with manufacturer programs to ensure applications are received and being processed.
• Document all activities within the electronic medical record per department policy.
• Proactively contact the patient or family by phone or electronically to ask questions about prescription coverage and financial information. When delays occur, ensure the patient or caregiver understands the reason for delay and what information or actions are needed to fill the prescription.
• Use critical thinking to solve problems and escalate issues to leadership when needed.
• Communicate effectively with pharmacists and clinic staff to address insurance issues or other issues requiring resolution that prevent timely prescription fulfillment.
• Receive and resolve patient billing questions and complaints in a compassionate, courteous, professional, and timely manner.
• Take actions to resolve issues such as denials, changing insurance, re-filing claims, contacting insurance companies, or answering questions.
• Identify and participate in continuous improvement opportunities and assist with implementing departmental planning and process improvements.
• Demonstrate the ability to communicate with patients and insurance companies regarding sensitive financial matters.
• Assist with training of new team members as requested by leadership.
• Process statements, payments, refunds and adjustments to patients and insurance companies through the 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…