Job Specification

Purpose of Position :

To provide administrative and clerical support services to the Exceptional Access Program Unit.

Duties / Responsibilities :

The EAPB manages the Ontario Drug Benefit (ODB) Program including the: Trillium Drug Program (TDP); Seniors Co-payment Program (SCP); Exceptional Access Program (EAP); Compassionate Review Policy (CRP); Special Drugs Program (SDP); Inherited Metabolic Diseases (IMD) Program; New Drug Funding Program (NDFP); Visudyne Program; Respiratory Syncytial Virus Prophylaxis (RSVP) Program; and the Health Network System (HNS). The EAPB also facilitates implementation of the Executive Officer of the Ontario Public Drug Program's policy framework for drugs reviewed by the Ministry's expert advisory committee, the Committee to Evaluate Drugs (CED) and provides the Division with business analysis and process development support.

The EAP unit is the operational unit of the EAPB that provides assessment of drugs that are not listed on the Ontario Drug Benefit formulary. The Support Clerk is one position within the EAP unit with duties and responsibilities to support the processing of EAP requests and to provide customer service support to the public as it relates to the processing of unlisted drugs and providing answers to questions from the public about EAP requests or the general questions related to the EAPB and the Ontario Public Drug Programs.

1. Assists in the processing of EAP reimbursement requests by:
- Entering data from the incoming documents/requests into the EAP database for the clients' files. Data entered primarily includes; patient and physician data, drug name, and drug indication being requested. Within the data entry process, responsibility for determining if the request is an initial request, renewal request, appeal or a follow-up for a prior response and responsibility for checking and updating existing client files; identifying missing contact or patient information, such as physician's fax number, phone number and address, or patient's date of birth, or an error in patient's Health Card number. Contacting the sender to resolve entries by processing outgoing faxes to obtain missing information.
- Converting hard-copy format requests into the electronic format for processing by EAP (most requests are received directly by EAP in electronic format); attaching EAP numbers and ?saving? files.
- Separating electronic copies of requests to ensure the upload of single requests to the database.
- Entering the priority response categories for new and renewal requests (e.g., stat-rush, non-rush, rush, etc.); checking data files of renewal requests for consistency of information regarding the requested drug from the previous approval.
- Removing (redacting) patient and physician identifiers from requests, following the Branch's redacting procedures, as part of the processing of requests for review by external reviewers, or as needed for special requests to the EAP Branch or Unit. Redacted documents are reviewed by Pharmaceutical Claims Analysts before they are released to reviewers.
- Following up on ?failed? outgoing faxes from the Unit by contacting intended recipients, such as to verify their fax machines' availability, the
correctness of the fax number; and the re-sending of faxes.
- Endeavoring to ensure that the standards and service standards for their assigned tasks in the processing of an EAP request are met.

2. Provides telephone service for the Exceptional Access Program by:
- Answering telephone calls from the public during the published hours of service of the EAP as assigned/scheduled; providing only information to which the caller would be entitled, under the Ministry/Branch's privacy procedures and protocols.
- Providing responses to calls from clients for status checks related to an EAP request in accordance with the Personal Health Information Protection Act (PHIPA) and other related Ministry or Program policies, such as informing clients whether a response to their request has been sent to their Doctor, but without releasing any information as to the nature of the response. Placing outbound calls to respond to messages from clients (e.g., patients, pharmacists, or physicians).
- Identifying and triaging telephone calls requiring escalation or referral to another staff member. Maintaining polite, helpful, and empathetic relations with telephone callers, as a number of callers may be in stressful situations.
- Providing responses to questions made available through ?Frequently Asked Questions? scripts as assigned by the program or by using verifiable knowledge or government programs and resources; ensuring that a patient's personal information is provided only to an authorized person (normally the Doctor), consistent with privacy requirements ([PHIPA] and the Freedom of Information and Protection of Privacy Act [FIPPA]).
- Endeavoring to ensure that the Ministry and program service standards for the answering of telephone requests are met, e.g., within the expected timeframe for the particular type of request.
- Documenting telephone calls as required both electronically and manually.
- Referring calls requiring call escalation to the appropriate staff member as provided by internal guidelines. (The call escalations generally may require [but are not limited to] transfer to the problem pharmacist, Lead PCAs, Managers, and/or Issues Coordinator.).

3. Performs clerical tasks related to faxes and mail received or sent by the Exceptional Access Program by:
- Receiving, sorting, distribution and/or uploading of incoming ?mail? (e.g., faxes, letters, and documents), to the EAP. Performing fax operations and photocopying for the unit.
- Assisting the EAP program by ensuring that printers and photocopiers are maintained in good working order and identifying issues that may or will require technical support.

4. Performs clerical tasks related to file maintenance and archiving of Ministry material in accordance with Ministry policies and under the supervision of managers or their delegates.

5. Performs duties and responsibilities during the hours of service of the EAP program as assigned by the Lead and the Manager.

Staffing and Licensing :

N/A

Knowledge :

Position requires:
- Knowledge of office procedures is required to provide administrative and clerical support for the Unit in areas such as incoming/outgoing mail processing, answering telephone calls from the clients and the public and providing only information to which the caller would be entitled under Branch's privacy protocols, and performing filing, and minor office equipment service.
- Knowledge of the Branch's program activities and knowledge of available resources such as ?Frequently Asked Questions?, use of Ministry websites, sufficient to respond factually to telephone queries from patients, health care providers, and the public regarding the Branch's services.
- Position requires basic knowledge of other branches' related program activities, in order to respond to general enquiries about a service not provided by EAPB, and to re-direct such callers.
- Knowledge of ODP procedures for ensuring the completeness and the correct and timely processing of drug benefit requests, and for entering and updating of information on the database.
- Awareness of the requirements of PHIPA and FIPPA (privacy legislation) in order to appreciate the Branch's requirements for the Position's removing (redacting) of patient and physician identifiers from requests being processed, and the importance of utilizing discretion and good judgment regarding the release of information in order to ensure proper confidentiality when providing responses to telephone calls for status checks related to EAP requests, and in conducting related communications, such as through faxes and e-mails.
- Knowledge and ability to be trained in the use of customized databases such as the EAP application, and patient and physician databases which are used to enter and verify data from incoming documents to the EAP.

Skills :

Position requires:
- Verbal communication skills are required to respond to requests from callers for information on routine matters that may include (but is not limited to), the status of recent requests, and related questions, and to ensure that responses are provided tactfully and politely to meet customer service standards of the Ministry and program.
- Written communication skills are required to document/record information from telephone calls, and to respond to emails as required by the duties of the position.
- Ability to read and comprehend the information being received in order to carry out the duties and responsibilities of the position, such as reviewing and entering data from the incoming documents to the EAP database.
- Ability to detect any (potential) errors when entering data from the requests into the patient files and forms, checking contents against standard procedures for such requests, such as determining if there is any missing information, such as the patient's date of birth or Health Card number.
- Ability to locate and retrieve data by performing database searches of the files, requiring the use of the index structure to locate the correct data/files.
- Organizational and time management skills, accuracy, and attention to detail in order to maintain files and records for the Unit accurately and efficiently.
- Basic keyboarding, data entry, and word processing skills for entering data into a database, documenting of client forms/information, e-mailing, and faxing requests.
- Ability to work collaboratively with others.
- Ability to work efficiently within the fast-paced and demanding environment.

Freedom of Action :

Decision-making is required when selecting the most suitable procedures/methods within comprehensive guidelines and precedents, e.g., when processing incoming and outgoing mail, responding to telephone requests for routine information, maintaining unit's files and records, archiving files when appropriate.
Work assignments, accompanied by the Unit's general procedures, are carried out under general supervision of the Manager and the Lead, and are normally subject to limited checking by the Lead, however the Pharmaceutical Claims Analysts are assigned to review outgoing work of the support related to the preparation of external reviewer packages. Position is expected to resolve routine work problems, such as identifying missing or improper information, and would seek assistance if needed, referring to the Lead any unusual problems or questions not covered by the Unit/Branch's procedures. Position must independently exercise discretion and good judgement regarding the release of information to ensure proper confidentiality of program and personal information as outlined in FIPPA (privacy) legislation.
The Position is responsible for performing the duties and responsibilities of all assigned services in an accurate and timely manner.
The Position is accountable for following instructions including observing Protection of Privacy limitations on any information being provided to callers/clients; providing responses to questions made available through ?FAQ? scripts as assigned by the program or by using verifiable knowledge or government programs and resources. Position is accountable for providing general information to clients regarding the requests being processed for drug benefits and for assisting them with submitting any missing information, within the Unit/Branch procedures. Errors could normally be readily detected and corrected within the Unit with minor losses of time, however serious errors usually have an impact on the Unit.