Ambulatory Medication Access/Referral Coordinator

Prime Healthcare•Kankakee, IL

11h

About The Position

The Ambulatory Medication Access/Referral Coordinator provides expert-level operational support for Prime Healthcare’s Ambulatory Services Team across complex ambulatory pharmacy workflows. The role reviews and processes referrals, coordinates patient scheduling and outreach, maintains accurate activity and outcome records in the electronic medical record (EMR), and evaluates insurance coverage to facilitate medication access. The coordinator helps implement workflows for new ambulatory pharmacy departments and validates the maintenance of workflows at existing departments. Serving as a liaison among providers, pharmacies, insurance carriers, and patients, the coordinator works to streamline medication access, reduce financial barriers, and support continuity of care. The role independently evaluates referrals for appropriateness, obtains clarifications from referring providers, and interviews and contacts patients to gather information and arrange scheduling as appropriate. It requires comprehensive expertise in prior authorizations, insurance types, specialty medication access, financial assistance, and 340B program requirements. The coordinator ensures prescriptions follow the steps needed to qualify for the 340B program and helps patients access pharmaceutical foundation programs, manufacturer copay assistance, internal assistance processes, and charity options. The coordinator uses independent judgment to prioritize work, manage patient issues, and support timely medication access. Depending on case acuity, the coordinator reviews cases with the Ambulatory Pharmacy Technician Supervisor or overseeing pharmacist. The role documents authorization outcomes, answers financial questions, manages uninsured and underinsured patient referrals, and serves as a subject matter expert and operational resource to clinical leadership, providers, and prior authorization coordinators.

Requirements

High school diploma or equivalent.
Current State of Illinois pharmacy technician license in good standing.
Certified Pharmacy Technician (CPhT) credential.
At least 3 years of experience in ambulatory care, specialty pharmacy, or 340B settings.
Proficiency with electronic medical record (EMR) systems and insurance authorization platforms.
Knowledge of HIPAA regulations and patient confidentiality standards.

Nice To Haves

Working knowledge of pharmaceutical foundation assistance programs and manufacturer copay card enrollment processes.
Experience qualifying and processing patients under 340B drug pricing program guidelines.
Strong understanding of commercial, Medicare, and Medicaid insurance plans and formulary requirements.
Experience coordinating patient outreach and scheduling in a high-volume clinical setting.
Excellent communication skills and ability to collaborate with providers, pharmacies, payers, patients, and external offices.
Strong organizational skills and ability to manage multiple cases and meet deadlines in a fast-paced environment.

Responsibilities

Review and process ambulatory care referrals and independently assess their appropriateness.
Collaborate with referring providers to clarify information and conduct patient outreach and interviews to gather additional information and coordinate scheduling.
Maintain accurate records of activities and outcomes in the electronic medical record.
Evaluate patient insurance coverage and manage prior authorizations to support medication access.
Implement medication access workflows for newly established ambulatory pharmacy departments and validate workflows at existing departments.
Serve as a liaison among providers, pharmacies, insurance carriers, and patients to streamline medication access and support continuity of care.
Ensure prescriptions follow the required steps to qualify for the 340B program.
Coordinate financial assistance, including pharmaceutical foundation programs, manufacturer copay assistance cards, internal assistance processes, and available charity options.
Review cases with the Ambulatory Pharmacy Technician Supervisor or overseeing pharmacist as appropriate based on acuity.
Prioritize workflow, manage patient problems, answer financial questions, and help ensure patients receive medications in a timely manner.
Document authorization outcomes and manage referrals for uninsured and underinsured patients.
Serve as a subject matter expert and operational resource to clinical leadership, providers, and prior authorization coordinators.