Focus Prescription Benefits Roles and Responsibilities

ROLES AND RESPONSIBILITIES 2024

WELCOME MESSAGE

Welcome to Focus Prescription Benefits! We’re excited to introduce you to the individuals who drive our organization. In this guide, we’ll walk you through our roles and responsibilities, showcasing how we can become your trusted ally in navigating the complex landscape of prescription medications.

MISSION

OUR MISSION IS TO WORK WITH OUR PATIENTS TO LIVE HEALTHIER LIVES BY IMPLEMENTING SOLUTIONS THAT DRIVE DOWN PRESCRIPTION DRUG COSTS AND DELIVER RESULTS THAT MAKE A DIFFERENCE, MEASURING OUR SUCCESS THROUGH SATISFIED PATIENTS, STRONG RELATIONSHIPS, AND EMPOWERED ADVOCATES.

WHO WE ARE

Focus Prescription Benefits is a dedicated high-cost medication management company that specializes in providing patients with a comprehensive pharmacy benefit solution for their expensive medications.

Our approach is centered around our Prescription Optimization Program (POP) team, which serves as a patient’s personal advocate, guiding them through the complex world of prescriptions to ensure they obtain their medications in a cost-effective manner. The POP team coordinates efforts between patients, healthcare providers, and pharmaceutical companies, exploring options such as copay cards and patient assistance programs to alleviate financial burdens. Additionally, our Personal POP Patient Advocates simplify the application process for patient assistance programs, making it easy for patients to access the support they need.

At Focus Prescription Benefits, we measure our success through satisfied patients, strong relationships, and empowered advocates. By prioritizing patient needs, delivering tangible results, and fostering a collaborative approach to healthcare, we strive to make a meaningful difference in the lives of those we serve. With Focus Prescription Benefits, patients can have peace of mind knowing they have access to the medications they need without hassle, empowering them to live healthier, more fulfilling lives.

TAMMY BEESON

Vice President, Operations

By fulfilling these responsibilities, Tammy contributes to the strategic direction and operational excellence of Focus Prescription Benefits, securing alignment with organizational goals, regulatory requirements, and client expectations.

Cross-Functional Collaboration and Relationship Building: Foster strong relationships across the leadership team and various departments to drive collaboration, influence decision-making, and optimize processes for overall effectiveness. Act as a liaison between departments, facilitating communication and alignment to achieve shared goals and objectives.

Technology Optimization and Infrastructure Management: Collaborate with internal partners to ensure that tools and technology are optimized to meet the evolving needs of a growing organization, enhancing efficiency and productivity. Oversee the implementation and integration of technology solutions, leveraging best practices to streamline operations and improve business outcomes.

Project Management Office (PMO) Oversight: Serve as the owner of the PMO office for CerpassRx and Focus Prescription Benefits, overseeing project management processes, standards, and governance frameworks. Deliver projects on time, within budget, and in accordance with quality standards, driving operational excellence and maximizing project success.

Regulatory Compliance and Reporting: Support all related SOC requirements for CerpassRx operations, confirming compliance with industry standards and regulations. Lead client performance guarantees reporting for CerpassRx, providing accurate and timely reporting to stakeholders and clients.

Salesforce.com Oversight: Provide oversight of Salesforce across the organization, including CerpassRx and Focus Prescription Benefits, leveraging the platform to drive sales effectiveness, customer engagement, and operational efficiency. Implement best practices for Salesforce.com administration, customization, and integration, supporting business objectives and maximizing ROI.

Critical Thinking and Decision-Making: Demonstrate strong critical thinking and decision-making abilities, leveraging data-driven insights and strategic analysis to inform key business decisions. Act decisively and confidently, considering the potential impact on stakeholders and aligning actions with organizational objectives.

Culture Alignment and Mission Adherence: Uphold and promote company culture, delivering alignment with the organization’s mission, vision, and values across all levels. Lead by example, embodying the core values of the organization and fostering a positive work environment conducive to collaboration, innovation, and continuous improvement.

Member Portal and Mobile App Management: Lead and facilitate all member portal and mobile app requirements and requests for CerpassRx, ensuring that the platforms meet user needs and deliver a seamless experience. Collaborate with internal teams and external vendors to implement enhancements and optimize functionality based on user feedback and industry best practices.

MICHELLE GUTIERREZ

Director, Operations

By effectively managing these responsibilities, Michelle plays a key role in driving team performance, ensuring patient satisfaction, and contributing to the success and growth of the organization.

Leadership and Motivation: Provide leadership and motivation to departmental personnel, fostering a positive and productive work environment.

Supervision and Oversight: Oversee all Supervisors and Patient Advocates for day-to-day operations, ensuring smooth workflow and adherence to guidelines.

Team Support and Development: Provide encouragement to team members, communicate team goals, and identify areas for new training and skill development. Assist management with hiring processes and new team member training, facilitating effective onboarding and integration.

Guidance and Problem Resolution: Answer team member questions, address problems, and oversee work for quality and guideline compliance, providing guidance and support as needed.

Communication and Meetings: Conduct team meetings to update members on best practices, expectations, and continuing education opportunities, fostering a culture of continuous improvement.

Program Development and Maintenance: Contribute to the definition, design, documentation, and maintenance of the POP, providing effectiveness and alignment with organizational goals.

Program Understanding and Alignment: Understand the details of how the POP works with patients and clients, ensuring alignment of processes with all stakeholders internally and externally.

Stakeholder Liaison: Act as a liaison between external and internal stakeholders, facilitating communication and alignment of objectives.

People Management and Development: Support Supervisors in day-to-day people management and processes, providing coaching and development opportunities to ensure all business objectives are met. Establish solid plans for team members’ career development, fostering growth and retention within the organization.

Culture Alignment and Mission Adherence: Uphold and promote company culture, ensuring alignment with the organization’s mission, vision, and values, fostering a positive work environment conducive to collaboration and continuous improvement.

Critical Thinking and Decision-Making: Demonstrate strong critical thinking and decision-making abilities, leveraging datadriven insights and strategic analysis to inform key business decisions and drive positive outcomes.

Patient-Centric Mindset and Culture Alignment: Maintain a patient-centric mindset and a high sense of urgency in all interactions and decisions, upholding company culture and aligning with the mission, vision, and values.

Service Excellence: Provide quality client and patient service, interact with clients/patients, answer inquiries, and handle escalated complaints effectively, promoting client and patient satisfaction.

KARLEEN GOODWIN

Director, Client Experience

By effectively managing these responsibilities, Karleen plays a key role in advancing the mission and vision of Focus Prescription Benefits, driving business success, and delivering value to our clients, stakeholders, and team members.

Strategic Direction with VP: Collaborate with the VP on defining and implementing strategic initiatives for Focus Prescription Benefits, aligning with organizational goals and trends.

Market Monitoring and Program Enhancement: Monitor market competition to identify opportunities for program enhancement, ensuring that Focus Prescription Benefits remains competitive and innovative in the industry.

Operational Excellence and Process Improvement: Utilize operational skills, quantitative analysis, and business knowledge to proactively identify problems and opportunities, making recommendations and implementing new programs and process improvements.

Leadership Over Implementation/ Account Managers: Provide leadership and guidance to the Implementation/ Account Managers, ensuring effective management of client relationships and successful implementation of the POP.

Client Relationship Management: Manage client relationships, overseeing the POP implementation, and addressing client escalations and concerns in a timely and effective manner to ensure client satisfaction and retention.

Marketing and Sales Support: Support marketing and sales initiatives, including responding to RFPs and participating in finalist meetings related to the POP, contributing to the acquisition and retention of clients.

Technology Optimization: Work with internal partners to ensure that tools and technology are optimized to meet the needs of a growing organization, enhancing efficiency and productivity across the board.

Business Operations Enhancement: Actively contribute to the enhancement of business operations processes, collaborating with cross-functional teams to streamline workflows and optimize organizational effectiveness. Act as a liaison between external and internal stakeholders, facilitating communication and alignment to achieve shared goals and objectives.

Cross-Functional Collaboration: Build strong relationships across the leadership team and other departments to influence decision-making, drive process optimization, and foster a culture of collaboration and innovation.

Hiring and Training

Support: Manage client relationships, overseeing the POP implementation, and addressing client escalations and concerns in a timely manner to establish client satisfaction and retention.

Support for Director of Operations: Support and collaborate with the Director of Operations, contributing to the overall success of operational initiatives within Focus Prescription Benefits.

Culture Alignment and Mission Adherence: Uphold and promote company culture, facilitating alignment with the organization’s mission, vision, and values, fostering a positive work environment conducive to collaboration and continuous improvement.

Critical Thinking and Decision-Making: Demonstrate strong critical thinking and decision-making abilities, leveraging datadriven insights and strategic analysis to inform key business decisions and drive positive outcomes.

IMPLEMENTATION/ ACCOUNT MANAGER RESPONSIBILITIES

By effectively managing these responsibilities, the Implementation/ Account Manager plays a critical role in providing successful client implementations, fostering strong client relationships, and driving business growth and retention for Focus Prescription Benefits.

Continuous Learning and Improvement:

Remain flexible and open to learning new ideas and skills, adapting to changes in the industry and evolving client needs. Contribute to ongoing process improvement initiatives and special projects as necessary, driving operational excellence and efficiency.

Data Gathering and Coordination: Gather all necessary data from the Sales team for new clients, ensuring completeness and accuracy. Coordinate internal kick-off calls to discuss operational requirements and expectations.

International Provider Setup and Data Management: Confirm setup is complete and accurate with our international provider, maintaining data integrity and compliance. Keep client documents, contacts, and plan design parameters up to date, ensuring accessibility and accuracy.

Onsite Support and Monitoring: Be available to travel onsite to meet clients during implementation if desired, providing personalized support and guidance. Monitor pharmacy claims processing during go-live, addressing any issues or concerns promptly.

Liaison and Communication: Serve as an effective liaison between clients, brokers, consultants, and internal departments, facilitating clear and timely communication. Maintain confidentiality and adhere to HIPAA requirements in all communications and interactions.

Client Interaction and Support: Act as the primary point of contact for clients during implementation, providing support and guidance as needed. Review the POP benefits with clients thoroughly and execute client signatures.

Problem Solving and Flexibility: Monitor operational processes during go-live and assist in developing problemsolving strategies as needed. Demonstrate independent judgment, excellent reasoning ability, and professional communication skills in addressing challenges.

Client Retention and Renewals: Take responsibility for client retention and securing contract renewals, ensuring ongoing client satisfaction and loyalty. Evaluate and monitor pharmacy data to provide consultative observations and opportunities to clients, demonstrating added value.

Implementation Leadership: Lead implementation kick-off calls/meetings and subsequent discussions with clients, ensuring all stakeholders are aligned. Coordinate and lead implementation meetings, ensuring adherence to project timelines and goals.

Assistance with Sales and Onboarding: Assist in selling to and onboarding new clients through current Third-Party Administrators (TPAs), Health Plan clients, and vendors, contributing to business growth and expansion.

REBECCA THOME Senior, Implementation/Account Manager

SAMANTHA JESSE Implementation/Account Manager

PATIENT ADVOCATE SUPERVISOR RESPONSIBILITIES

By effectively managing these responsibilities, the Patient Advocate Supervisor plays a crucial role in ensuring the smooth operation of the POP, maintaining high-quality patient support, and driving overall excellence within the team.

Reporting to Director of Patient Advocates: Provide weekly updates to the Director of Patient Advocates regarding team performance, progress, and any relevant issues or challenges. Perform other projects as assigned, contributing to the overall success and effectiveness of the Patient Advocacy team and the organization.

Confidentiality and HIPAA

Compliance: Maintain confidentiality and adhere to HIPAA requirements in all interactions and processes, ensuring patient privacy and data security.

TANYA WOODERS

Patient Advocate Supervisor

Knowledge Sharing and Training: Share knowledge and train team members on workflows and job requirements, contributing to team cohesion and effectiveness.

Collaboration with Training Manager: Collaborate with the Training Manager in creating and managing quality processes, ensuring consistency and adherence to standards.

SFupport for the POP Team: Address questions, manage problems, and provide resolutions related to the POP, ensuring smooth operations and effective patient support.

Call Reporting and Documentation: Learn and create call reports for internal use, providing valuable insights and data for analysis and decisionmaking.

Quality Assurance and Monitoring: Monitor the POP Patient Advocate calls for quality assurance, facilitating adherence to protocols and standards.

Operational Support and Problem

Solving: Monitor operational processes and assist in developing problem-solving strategies, leveraging independent judgment, reasoning ability, and excellent communication skills.

lexibility and Critical Thinking: Demonstrate flexibility, critical thinking skills, and openness to learning new ideas and skills, adapting to changing needs and circumstances.

Client Service Excellence: Provide accurate and timely information to internal and external clients in a professional, responsive, and serviceoriented manner, fostering positive relationships and client satisfaction.

LINDA HUSTON Patient Advocate Supervisor

HOLLIE PHILIPS Patient Advocate Supervisor

SENIOR, PATIENT ADVOCATES

Utilization of POP Program Benefits: Work with clients and patients to ensure they understand and utilize all the benefits available through the POP, providing guidance and support as needed.

Forms and Data Management: Manage and process incoming and outgoing forms, information, and data to provide patient assistance, ensuring accuracy and compliance with regulations.

Inbound and Outbound Call Management: Take all inbound calls from patients, providers, and pharmacies, recording them on cases and following up to resolution. Make outbound calls to patients, providers, and pharmacies based on inbound call inquiries, ensuring timely follow-up and resolution. Work incoming cases that come in from 7:00 PM CT – 9:00 AM CT, providing round-the-clock support to patients and stakeholders.

BY EFFECTIVELY MANAGING THESE RESPONSIBILITIES, SENIOR PATIENT ADVOCATES PLAY A CRITICAL ROLE IN PROVIDING HIGH-QUALITY SUPPORT TO PATIENTS, FACILITATING EFFECTIVE COMMUNICATION AND RESOLUTION OF ISSUES, AND CONTRIBUTING TO THE SUCCESS OF THE PRESCRIPTION OPTIMIZATION PROGRAM AND OVERALL PATIENT SATISFACTION.

Savings Recording and Case Management: Record any savings and clone future saving cases, ensuring accurate tracking and reporting of cost-saving measures.

Collaboration and Team Support: Collaborate with all internal and external teams to support the POP, fostering a cohesive and integrated approach to patient care and support.

Patient-Centric Approach:

Manage every call with a patient-centric mindset and a high sense of urgency, resolving issues accurately, demonstrating compassion, and ensuring a hassle-free experience for patients, providers, and pharmacies.

Documentation and Follow-Up:

Maintain documentation and follow-up skills, ensuring accurate recording of every call, including details of the drug and case, and consistently following up to resolution.

Triage and Care Coordination:

Provide appropriate triage and care coordination to clients, patients, providers, and pharmacies, ensuring seamless communication and resolution of issues.

Project Work and Campaigns: Handle any project work, such as updates for BOB rollouts, and proactive outbound call campaigns for new clients, ensuring case completion through resolution.

Documentation and Follow-Up: Ensure accurate documentation and follow-up on all cases, including details of the drug and case, to maintain comprehensive records and facilitate efficient resolution.

Triage and Care Coordination: Provide appropriate triage and care coordination to clients, patients, providers, and pharmacies, ensuring seamless communication and resolution of issues.

Recording of Savings and Project Work: Record any savings and clone future saving cases, ensuring accurate tracking and reporting. Handle any project work, such as updates for BOB rollouts, and proactive outbound call campaigns for new clients, ensuring case completion through resolution.

Collaboration with Internal and External Teams: Collaborate effectively with all internal and external teams to support the POP program, fostering a cohesive approach to patient care and support.

Handling PA/Clinically

Approved Cases: Handle incoming PA/clinically approved cases that come in from 9:00 AM CT – 7:00 PM CT, providing timely and efficient assistance to patients.

Utilization of POP Program Benefits: Work closely with clients and patients to ensure they understand and utilize all the benefits available through the POP, providing guidance and support as needed.

Management of Rejected POP Claims: Work daily rejected POP claims by making outbound calls, processing JMT tickets, and following up on associated reject cases to achieve resolution. Make outbound calls to patients, providers, and pharmacies based on rejected claim cases assigned daily, ensuring timely resolution.

Forms and Data Management: Manage incoming and outgoing forms, information, and data to provide patient assistance, ensuring accuracy and compliance with regulations.

Call Management and Patient-Centric Approach: Manage every call by accurately resolving the issue, demonstrating compassion, meeting compliance requirements, and ensuring a hasslefree experience for patients, providers, and pharmacies. Maintain a patientcentric mindset and a high sense of urgency in all interactions and tasks.

Collaboration and Team Support: Collaborate with all internal and external teams to support the POP, fostering a cohesive and integrated approach to patient care and support.

PATIENT ADVOCATES

BY EFFECTIVELY MANAGING THESE RESPONSIBILITIES, PATIENT ADVOCATES PLAY A CRUCIAL ROLE IN PROVIDING ESSENTIAL SUPPORT TO PATIENTS, RESOLVING ISSUES EFFICIENTLY, AND CONTRIBUTING TO THE SUCCESS AND EFFECTIVENESS OF THE PRESCRIPTION OPTIMIZATION PROGRAM.