Work directly with patients, Specialty Pharmacy staff, and clinic staff to manage the specialty medication needs of Mass General Brigham patients. Understand the complex medication needs of patients and coordinate with pharmacy and medical/nursing staff to meet those needs while providing extraordinary service. Assist patients with benefit coordination and financial assistance, manage prior authorizations, and ensure patients receive their medications at the appropriate time.
Principal Duties and Responsibilities:
Work with physicians, nurses and pharmacists to ensure that each patient receives the medications he/she needs at the appropriate time:
- Review medication regime with patient to determine which medications need to be dispensed
- Process medication orders confirming that they are billed to all third parties correctly
- Monitor patient concerns, charts and profiles to meet their medication therapy needs
Support MGBSP Patient Needs:
- Answer patient questions about the service, insurance issues, financial assistance needs, etc
- Ensure all questions are answered timely and accurately
- Ensure clinical questions are appropriately escalated to a pharmacist
- Ensure employee back-up coverage is trained and knowledgeable
- Report any Patient Safety Events according to MGB SP guidelines
Commit to Building Relationships:
- Quickly forge and sustain (or develop and maintain) strong relationships with pharmacists, co- workers, prescribers, nurses and patients to build/support the services we provide
- Provide caring service, adjusting approaches to reflect developmental level and cultural differences of population served
- Improve processes to facilitate communication and service between patient, and clinic, infusion center and discharge pharmacy teams to ensure accurate and timely delivery of medications
- Participates in MGB SP Clinical Subcommittees
Act as the insurance specialist:
- Understand Medicare/Medicaid regulations and billing guidelines as they pertain patient pharmacy benefits
- Understand billing primary, secondary and tertiary insurance claims
- Resolve any billing issues and obtain Prior Authorizations for medications.
- Obtain benefit information and verify patient insurance eligibility and level of coverage
- Cross train within PCC roles as directed to support emergent and ongoing business needs.
Demonstrates Commitment to Customers:
- Seeks to understand and value differences between employees
- Treats other employees with dignity and respect
- Demonstrates open, honest communication and behavior
- Resolves conflict in a positive manner
- Contributes to the productivity of the workgroup
- Use/s the Mass General Brigham values to govern decisions, actions and behaviors. These values guide how we get our work done: Patients, Affordability, Accountability & Service Commitment, Decisiveness, Innovation & Thoughtful Risk; and how we treat each other: Diversity & Inclusion, Integrity & Respect, Learning, Continuous Improvement & Personal Growth, Teamwork & Collaboration
- Provide immediate call support to patients, caregivers, and clinics as needed.
- Other duties as assigned
Demonstrates Commitment to Fellow Employees:
- Seeks to understand and value differences between employees
- Treats other employees with dignity and respect
- Demonstrates open, honest communication and behavior
- Resolves conflict in a positive manner
- Contributes to the productivity of the workgroup
Demonstrates Commitment to Health System:
- Lives the values of dignity, integrity, service and compassion
- Supports the mission/vision
- Speaks positively about Health System
- Chooses to make Health System a better place
Mass General Brigham Incorporated is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.
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Mass General Brigham (Enterprise Services)
Jan 15, 2025