Under direction of the Prescription Assistance Supervisor and within federal, state and local guidelines performs complex (journey-level) human services support work and eligibility determination for prescription assistance programs (PAP). Work involves reviewing clients' records, interviewing clients, documenting client information, determining client eligibility for different PAP programs, verifying case data, explaining PAP benefits and requirements and providing information to clients or assisting staff in the delivery of social services. May train others.
This position adheres to all applicable laws, regulations, policies and procedures of the Health and Human Services Commission (HHSC), and DCMHMR.In addition, this position assists consumers who are indigent and without Medicaid or other prescription coverage to procure their medications from numerous pharmaceutical companies at no cost or low cost for psychiatric medications prescribed by DCMHMR physicians or Nurse Practitioners.Works under moderate supervision, with limited latitude for the use of initiative and independent judgment.
Education, Training, and Experience
·High School Diploma or General Education Degree required.
·Prefer one to two years of college or work experience.
·Good communication and organizational skills a plus.
·Prefer knowledge of logging and managing inventory systems.
·Prefer knowledge of psychiatric medications.
Registration, Certification, Licensure, and Other Qualifications
- Must have and maintain a background and criminal history free from any disqualifying offenses as outlined by the Texas Administrative Code (TAC) and the Health and Human Services Commission (HHSC).
- Must possess and maintain a valid driver's license and automobile insurance.
oIndividuals with an out-of-state driver's license must be able to obtain a driver's license in the state of Texas within thirty (30) days.
·Successful completion of all position-specific training within thirty (30) days of employment is required.
Knowledge, Skills, and Abilities
·Skill in the operation of computers, applicable computer software, and office equipment.
·Ability to negotiate services, to communicate effectively, to evaluate information, to perform basic arithmetic and data analysis, and to train others
·Ability to display regular and reliable in-person attendance.
·Knowledge of the needs, problems, and community environments of persons with disabilities; of community and government service delivery systems; of case management systems; and of community welfare resources.
·Understanding and practice of Trauma Informed Care principles.
Essential Duties
The following list outlines key responsibilities for the position; however, it is not exhaustive and does not encompass all responsibilities. Additional duties may be assigned as needed.
1.Identifies eligible clients to enroll in a Prescription Assistance Program (PAP); and obtains, verifies, and calculates income and resources to determine eligibility for PAP.
o Reviews clinic schedule for PAP reports at least once per week. Also receives referrals from prescribers or clinic staff for new PAP enrollments as needed.
o Enters new PAP eligible clients in Med Data Services within 2 business days of receiving client's information.
o Updates existing PAP eligible clients' information in Med Data when notified of a change within 2 business days.
o Refers to individual PAP guidelines to determine client eligibility.
2.Generates and assists clients in completing and submitting PAP applications (for psychiatric medications only). Works with Psychiatric Clinic Assistants (PCAs), Nurses, and prescribers to secure needed scripts, signatures, and other information needed to complete application.
o When notified by PCA or other clinic staff, generates applications and obtains requires client signatures while client is still at center. Meets with clients either in front desk lobby, or in check-in room with nursing staff present to fill out required PAP paperwork.
o Generates applications for PAP renewals for upcoming appointments and notifies PCAs and/or prescribers the morning of client's next appointment.
o Highlights areas on applications that need to be completed or communicates instructions to the appropriate staff.Educates staff and clients on PAP application processes and requirements.
o Provides information about clients' PAP status when requested in a timely manner.
3.Maintains accurate logs of all PAP and RXOutreach medications ordered, received, and released to clients or staff in MedData
o Checks in all PAP medications received by end of day with a second staff member.Handles and stores all PAP meds in medication room according to center policies & procedures.
o Counts and co-signs for any PAP meds being sent to Genoa pharmacy.
o Runs weekly reports of upcoming medication refills needed to be reordered, and coordinates with fellow PAP staff to ensure orders are placed.
o Documents in Med Data each time an application is sent to the prescriber or client; an application is received back from the prescriber or client; an application is sent to the PAP company; PAP meds are received; or refills are ordered.
o Documents any status updates in Med Data, such as requesting documents from client, temporary approval, client missed appointment, more information needed from client, etc.
4.Maintains accurate log of all sample medications ordered, received, and released to clients or clinic staff in IPM tracking services.
o Logs all samples medications ordered or received through drug representatives in IPM
o Maintains sign-in and sign-out sheets located in med room, that clinic staff will utilize to keep an accurate log of sample medications available.
o Counts and verifies that medication amounts stored at clinic match records, along with a second staff member.Reviews inventory monthly for expired meds and identifies expired medications to set aside for disposal by nursing staff.
5.Utilizes the IPM benefits manager portal Tredium to update client enrollment for medication coverage
o Refers to documentation in client profile to determine dates of eligibility for enrollment into IPM for medication coverage.
o Coordinates with case management and consumer benefits staff to ensure clients are re-enrolled into IPM once missing or expired paperwork is completed.
o Looks into rejected claims processed by the pharmacy, to determine if an override needs to be placed or if PAP staff will need to seek out alternative solution with prescribers.
6.Monitors, reviews, and communicates client eligibility or enrollment status changes to the clients, authorized representatives, and appropriate staff as needed.
7.May consult with program staff on policies & procedures, work practices, records, budgets, and community resources as needed.
o Attends regularly scheduled PAP meetings.Provides updates on PAP reports requested by clinic management.
o Communicates any emergent issues or questions that arise related to PAP with Clinic Leadership in a timely manner.
o Informs prescribers, clinic management and clinic staff of any changes to PAP programs promptly.
8.Works with Consumer Benefits Staff to obtain needed documentation and verify information.
o Files copies of income documentation and sends to PAP companies as appropriate received from Consumer Benefits department.
o Contacts Consumer Benefits Supervisor to request assistance in obtaining any additional income documents needed, or to assist client in obtaining additional assistance.
9.Acts as the point of contact for pharmaceutical representatives and communicates with them to identify new PAP needs.
o Contacts pharmaceutical representatives to request samples, vouchers, or information when needed.
o Works with PCAs to coordinate meetings between pharmaceutical representatives and prescribers.
o Ensures all samples received are documented on sample sign in log, as well as in IPM.
Performs additional duties as deemed necessary by department supervisor within designated timeframes, which may include:
10.Documenting messages from nurse line and returns calls to clients as appropriate, referring calls to nursing staff as needed.
o Checks nurse line and accurately documents messages in a timely manner, at least once hourly, when assigned.Transcribes and sends each call to NIC or relevant clinic staff, and follows instructions given.Legibly documents any actions taken in client's record.
o Keeps a tally of calls received, making sure to differentiate the reason for the call, and to which facility it was addressed to, to maintain an accurate log of calls received in a given month.
11.Checks clinic fax line when assigned, at least hourly, to ensure correspondence is addressed in a timely manner
o Logs any documentation received pertaining to PAP enrollments, and sends to relevant PAP team member, including but not limited to: PAP approvals, PAP denials, requests for missing/additional information for PAP applications, notice of PAP eligibility expiring soon, etc.
o Saves and sends any documentation received pertaining to other departments, including but not limited to: requests for documentation; documentation from other healthcare facilities; Prior Authorizations; requests from pharmacies to process medication refills, etc.
12.Participates in the Center's Zero Suicide Initiative.
o Supports individuals experiencing a crisis by promptly connecting them with appropriate Center programs, such as the Mobile Crisis Outreach Team (MCOT), Psychiatric Triage, Crisis Prevention services, and/or other applicable resources. Ensure seamless coordination to facilitate timely intervention.
o Remains with individuals, when deemed safe, to provide support and maintain a calm environment until specialized crisis staff or emergency personnel arrive to take over intervention efforts. Adheres to safety protocols to prevent escalation of the crisis situation.
o Participates in debriefing sessions with the immediate supervisor or designated staff following a crisis event. Collaborate with the team to review the incident, identify lessons learned, and ensure all HHSC guidelines and Center policies are followed.