Regional Patient Advocate

Job Purpose:

The Company is seeking a highly motivated, self-starter who is looking for growth and a challenge.  We are seeking experienced Certified Pharmacy Technicians who are nationally certified (PTCB and ExCPT acceptable) and are registered within the state of the clients and have a proven track record providing exceptional patient care as a PSA/Engagement Specialist or Pharmacy Technician.  Should state certification need to be obtained for a particular state or updated based on the health system that is supported, the applicant will commit to obtaining the required certification within a mutually agreed upon timeframe.  Continued employment is contingent upon meeting these requirements.  

Critical to this position is a person who is able to establish strong and credible relationships with patients, clinicians and internal Shields staff in a data driven and collaborative team environment.  Applicants should be results-oriented with a positive outlook, and a clear focus on high patient quality and service. A natural forward-planner who critically assesses own performance while accepting and implementing constructive feedback.  Mature, well-presented, professional, and comfortable in dealing with patients or clinic staff on the phone.  Applicant must be reliable, tolerant, and determined; an empathic communicator, able to see things from the other person's point of view.   

This position will provide support to patients, pharmacists, and providers by providing a full-service approach to total quality patient care. Works closely with patients to deliver a full continuum of medication adherence support by utilizing our various tools and applications. This role will require the ability to quickly pivot disease states and clinics supported based on current need. This role will provide these services remotely as part of the centralized Patient Support Center (PSC) team located in Stoughton, MA or Phoenix, AZ based on need of role. 

Job Duties: 

• Provide implementation and stabilization for new clinics and partners as needed
• Work with supervisor to onboard a permanent Patient Support Advocate/Patient Engagement Specialist hired for your assigned clinic/location
• Stabilize new hires and set them up for success in new role
• Work with Supervisor to recommend workflow enhancements to help the clinic deliver the highest level of patient care
• Adapt quickly to new environments and therapeutic areas in order to operate effectively as a Patient Support Advocate
• Provide coverage of clinics where there are staffing gaps
• Actively participate in process improvement initiatives
• Engage with entire team to identify areas to assist in Prior Authorizations and Financial Assistance
• Update knowledge by participating in educational opportunities; reading professional publications; maintaining networks; participating in professional organizations
• Maintain PSA or PES responsibilities during assignments. Responsibilities include (but are not limited to):
• Coordinate with third-party insurance, clinical staff, and patients to effectively process prior authorization requests for medications within the prescribed timelines. Compile clinical documentation for prior authorizations (ex: progress notes, labs, diagnoses codes, previously tried therapies, doctor visits)
• Verifies insurance eligibility and benefit levels
• Document all account activity and correspond to inquires in a timely manner.
• Directly enroll eligible patients into manufacturer patient assistance and co-pay programs, foundations, and/or manufacture assistance programs
• Communicate with patients to complete specialty refills
• Performs the following functions within the pharmacy dispensing system:
• Completes a full benefit investigation by running a test claim or utilizing eligibility lookup tools
• Properly troubleshoot rejections/errors within test claims to understand patients benefits/eligibility
• Add/Edit patient insurance plans as necessary
• Ability to be flexible on shift times: typical shift times:  8:30AM to 5:00PM but can differ based on time zone and clinic operating hours. Standard hours to be discussed at time of hire. Overtime and weekend hours may be required as needed.
• Apply observations and recommendations to operational issues, increased productivity, quality and customer-service standards
• Protect organization’s value by keeping information confidential
• Grow the specialty pharmacies patient population by strictly adhering to Shields’ programs and processes with enthusiasm and purpose
• Other duties or special projects as assigned

Experience/ Education: 

Required Licensure/Certification:  We are seeking experienced