Specialty Pharmacy Patient Advocate

POSITION SUMMARY

This position will determine, support and assist patients, provider teams, and the pharmacy department to overcome barriers to medication access, with focused expertise in third-party prior authorization and billing processes for pharmacy benefits. Assist patients with enrollment into grants, assistance programs, and communicate any financial responsibilities. Provide a face-to-face bedside-oriented service that delivers comprehensive fiscal options to patients and provide medication cost after transplant. Gather and effectively communicate medical and medication histories including diagnosis, test results, lab values, and appropriate step therapy to third-party for initial insurance approval. Verify eligibility, benefit provisions, and support the appeals process.

CORE FUNCTIONS

1.Coordinate with stakeholders to remove medication access barriers.

2.Maintain current knowledge of pharmacy regulations, payer agreements and assistance programs.

3.Provide timely medication benefit counseling to patients and hospital staff.

4. Accurate and timely execution of pharmacy projects as required.

5. Follow policies, procedures and regulatory requirements and perform other work assignments.

MINIMUM QUALIFICATIONS

Licensed and registered pharmacy technician in the state of practice, where applicable.Incumbents in Arizona are also required to provide the AZ Board of Pharmacy Wallet Card at time of hire.

Minimum of three years of healthcare and / or insurance / third party reimbursement experience required to include one year of technician experience required. Strong customer service focus, superior problem-solving abilities required. Proficiency in Microsoft Word, Excel, network, web-based and payer applications required. Ability to anticipate customer requirements and meet those needs in an appropriate and timely manner is required. Ability to prioritize organization requirements and track progress of multiple initiatives.

PREFERRED QUALIFICATIONS

Completion of a Pharmacy Technician Certification Program.

Associate’s or bachelor’s degree in business, healthcare or related field preferred. Prior authorization experience in specialty or retail pharmacy preferred. Knowledge of commercial, Medicare B, Medicare D and Medicaid pharmacy rules and regulations preferred. Knowledge and experience utilizing McKesson Enterprise, Cerner and Therigy preferred Bi-lingual preferred

Additional related education and / or experience preferred.

DATE APPROVED 03 / 30 / 2025

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EEO / Disabled / Veterans

Our organization supports a drug-free work environment.

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