In collaboration with patients, families (as defined by the patient) and staff across all disciplines and departments is responsible for assisting patients in obtaining prescribed medications through Pharmaceutical Patient Assistance Programs (PAP) and through insurance prior authorizations.
Essential Duties (at least 5 that are non-negotiable duties and are absolutely pertinent to successfully completing the job without accommodations):
Initiate, assist and coordinate with the specialty provider teams on assistance with the Prior Authorizations/Non-Formulary Drug Requests for Commercial, Medicaid, Medicare D, MAP and Sliding Fee Scale medication claims.
Initiate, assist and coordinate with primary care provider teams on Prior Authorizations/Non-Formulary Drug Requests for MAP and Sliding Fee Scale medications
Submit manufacturer assistance program applications to providers for review, signature and forward completed applications and related paperwork to the appropriate patient assistance program
Explain the Patient Assistance Program (PAP) procedures to patients and assist patients in accurately completing program applications and obtaining required documentation
Document and maintain accurate records
Create and maintain confidential patient files
Maintain follow up with patient applications and assistance programs as required
Receive, document and store medication(s) received from patient assistance programs
Contact patient, coordinate delivery of medication to patient through internal pharmacy
Maintain attestations and competencies through Compliance 360 in accordance to the PAP Manual
Serve as liaison between Patient Assistance Programs, patients, clinic staff, eligibility staff and outsourced pharmacies.
Educate and train PAP Services technicians as necessary or instructed
Work/Cross train in internal Class A and D pharmacy operations for the purposes of maintaining competencies in those respective environments
Ensure all actions, job performance, personal conduct and communications represent CommUnityCare in a highly professional manner at all times
Ensure all tasks provided and associated with patient care, patient administrative processes and related duties comply with all regulatory and accreditation standards including The Joint Commission and CommUnityCare Standard Operating Procedures and CommUnityCare Policies and Procedures
Uphold and ensure compliance and attention to all company policies and procedures as well as the overall mission and values of the organization
Develop and maintain favorable internal relationships, partnerships with team members, including clinical managers, clinical support staff, providers and business office staff
Perform other duties as assigned
Possess the clinical knowledge required to complete insurance prior authorization requests for specialty care provider needs
Possess the clinical knowledge required to complete pharmaceutical manufacturer-specific forms to obtain medications or medication coverage for specialty care provider needs
Possess the knowledge required to complete prior authorization forms for MAP and SFS to obtain medications or medication coverage for patient and provider needs
Maintain an exceptional level of communication with patients and ensure they receive status information in a timely fashion
Interact respectfully and collaboratively with patients and their families, striving to develop favorable relationships with families
Collaborate with all members of the care team in providing patient-centered care
Complete all mandatory training and maintain appropriate credentials/licensure
MINIMUM EDUCATION: High School Diploma or equivalent
MINIMUM EXPERIENCE: Five years of related experience
PREFERRED EXPERIENCE: Bilingual in Spanish
(1) Current Pharmacy Technician Registration with the Texas State Board of Pharmacy.
(2) Current Health Care Provider Cardiopulmonary Resuscitation (CPR) certification through American Heart Association or American Red Cross. Will be required to maintain a current CPR certification during employment.