The University of Rochester is looking for a Pharmacy Access Rep III - Specialty Pharmacy to be responsible for the overall management of drug access for high-cost specialty and restricted access drugs in assigned clinics. You will collaborate with clinical staff to ensure patients receive necessary treatments.
What You'll Do
- Maintain knowledge of major payer policies for clinic-administered drugs requiring prior authorization and work with clinic staff to ensure all required elements are met.
- Submit prior authorization requests to payers and manage the submission of any supplemental information requested.
- Review all prior authorization denials, determine the reason, and prepare a response with necessary additional information.
- Document all prior authorizations in the electronic medical record, including the authorization number and dates of approval, and track renewals to prevent treatment delays.
- Remain up-to-date on all potential patient assistance programs relevant to high-cost drugs used in the assigned clinic(s).
- Prospectively evaluate every patient receiving high-cost drug therapy for potential patient assistance program participation and identify the best option(s).
- Meet with patients and families to obtain necessary information, present assistance program options, and enroll patients using required mechanisms.
- Submit all required documentation to the patient assistance program throughout treatment to ensure payment for each dose and continued coverage.
- For governmental payers, manage patient-specific inventory for no-cost drug and ensure documentation suppresses patient charges.
- Track all payments received from patient assistance programs and provide monthly, quarterly, and annual reports summarizing patient out-of-pocket savings.
- Track all no-cost drug received for patients with governmental payers and quantify savings on a monthly, quarterly, and annual basis.
- Conduct benefits investigations for high-cost drugs and discuss patient obligations with patients and families.
- Understand and manage the payment process specific to each patient assistance program, ensuring payments are properly applied.
- Work collaboratively with Patient Financial Services to ensure patient bills are held pending program payment and final bills are accurate.
- Act professionally, courteously, and diligently in all interactions with staff and patients.
- Collect patient satisfaction survey data regularly to assess satisfaction and the drug management process.
What We're Looking For
- An associate's degree in a medical, secretarial, or related field and 3 years of relevant experience, or an equivalent combination of education and experience.
- Capability to work independently with minimum supervision.
- Strong communication skills, problem-solving abilities, and a professional presentation.
- Demonstrated customer relations skills.
Nice to Have
- Knowledge of medical terminology.
- Experience with medical and surgical scheduling software and electronic medical records.
- A Certified Pharmacy Technician (PTCB) certification upon hire.
Technical Stack
- Electronic medical records systems.
- Medical and surgical scheduling software.
Team & Environment
You will collaborate closely with clinical staff, including providers, nurses, and other patient care staff, as well as Patient Financial Services.
Benefits & Compensation
- Compensation range: $21.71 - $29.31 per hour.
Work Mode
This is an onsite position located at 120 Corporate Woods, Rochester, New York, 14623.
The University of Rochester is committed to fostering, cultivating, and preserving an inclusive culture and does not discriminate on the basis of age, color, disability, ethnicity, gender identity or expression, genetic information, marital status, military/veteran status, national origin, race, religion, sex, sexual orientation, or any other characteristic protected by law.
