A Brief Overview

The Patient Support Advocate is knowledgeable about pharmacy and manufacturer assistance programs, insurance coverage (limitations, requirements, eligibility, formularies, prior authorizations, benefits investigations, etc.), available community and national resources, ICD-9 codes, and determinants of financial need. They display an understanding of pharmaceutical terminology (brand, generic, dose, route, etc.). The Patient Support Advocate (PSA) will work closely with pharmacy staff, clinic staff, and clinical pharmacist specialist to obtain the appropriate clinical and financial information for available assistance programs. The PSA is also responsible for providing patients and clinicians with accurate and up to date information regarding assistance programs, insurance eligibility, government subsidies, as well as maintaining a database with accurate patient and assistance program information. The PSA will work with the UH Ventures Pharmacy Services to make refill and other routine phone calls to patients and follow up on medication delivery.

What You Will Do

• Call Center Support
  • Answer incoming calls and respond to electronic communications
  • Assist health care providers and patients by greeting them by phone; answering questions and requests; referring inquiries to the site pharmacist(s) as needed.
  • Handle customer inquiries both telephonically and by email
  • Research required information using available resources
  • Manage and resolve customer complaints
• Medication Assistance (Access) Support
  • Process benefits investigations, prior authorizations, pre-certifications, and copayment assistance request for prescriptions received by the UH Home Care Specialty Pharmacy.
  • Maintain current knowledge of, requirements for and ability to enroll patients in: Pharmacy Assistance Program (PAP), manufacturer, state and local medication assistance programs; disease based assistance from non-profit organizations; Medicare prescription drug benefits; Social Security Low Income Subsidy; state and federal medication subsidy programs
  • Maintain documentation of patient status for resource programs in required databases
  • Evaluate all self-pay and underinsured patients for PAP/MAP eligibility and enroll patients based on financial need
  • Work collaboratively with clinical based pharmacist to obtain clinical and financial information needed for program enrollment
  • Utilize internally developed systems, commercial vendor software (to track patient eligibility, prescriptions, patient communications and program enrollment), outpatient clinical, scheduling and financial systems as necessary
  • Interact with physicians, nurses, and other health care professionals in a courteous and professional manner
• Display the highest level of customer service, attentiveness, and consideration possible in all situations
• Support all new team initiatives
• Elevate issues promptly to supervisors to promote positive outcomes for internal and external customer

Additional Responsibilities

• Performs other duties as assigned.
• Complies with all policies and standards.
• For specific duties and responsibilities, refer to documentation provided by the department during orientation.
• Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients. Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace.