Ambulatory Medication Access/Referral Coordinator

Prime Healthcare•Evanston, IL

1d•Onsite

About The Position

The Ambulatory Medication Access and Referral Coordinator provides expert-level support to the Prime Healthcare Ambulatory Services Team across complex ambulatory pharmacy workflows, including referral review and processing, patient scheduling, activity and outcome recordkeeping, and insurance evaluation to help patients access medications. The coordinator helps implement medication access workflows in newly established ambulatory pharmacy service departments and validates the maintenance of workflows at existing departments. The role serves as a liaison among providers, pharmacies, insurance carriers, and patients to streamline access, reduce financial barriers, and support continuity of care. The coordinator independently evaluates referrals for ambulatory care services, determines referral appropriateness, works with referring providers to clarify information, and conducts patient outreach and interviews to gather information and arrange scheduling as appropriate. The position maintains accurate records of activities in the electronic medical record (EMR). It requires comprehensive expertise in prior authorization management across insurance types, specialty medication access, and financial assistance coordination in ambulatory care settings. The coordinator applies knowledge of 340B program requirements and ensures prescriptions complete the necessary steps to qualify. Financial assistance work includes pharmaceutical foundation programs, manufacturer copay assistance cards, and internal medication assistance processes. Depending on the acuity of medication access needs or referrals, the coordinator reviews cases with the Ambulatory Pharmacy Technician Supervisor or overseeing pharmacist to help avoid gaps in care. The role uses independent judgment to prioritize work, manage patient problems, and help ensure timely medication access. Responsibilities include facilitating insurance authorization, answering financial questions from patients and providers, documenting authorization outcomes, managing uninsured and underinsured patient referrals for available assistance and charity options, and serving 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 effectively 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.
Experience with specialty pharmacy.

Responsibilities

Review, process, and independently evaluate patient referrals for ambulatory care services and determine whether they are appropriate.
Collaborate with referring providers to clarify information and conduct patient outreach and interviews to collect additional information and arrange scheduling as appropriate.
Maintain accurate records of activities and outcomes in the electronic medical record (EMR).
Evaluate patient insurance and manage prior authorizations across insurance types to support medication access.
Help implement medication access workflows in newly established ambulatory pharmacy service departments and validate maintenance of workflows at existing departments.
Coordinate access to specialty medications and financial assistance, including pharmaceutical foundation programs, manufacturer copay assistance cards, and internal assistance processes.
Apply 340B program requirements and ensure prescriptions go through the necessary steps to qualify.
Serve as a liaison among providers, pharmacies, insurance carriers, and patients to streamline medication access, reduce financial barriers, and support continuity of care.
Review cases with the Ambulatory Pharmacy Technician Supervisor or overseeing pharmacist, as appropriate, to help avoid gaps in care.
Prioritize workflow, manage patient problems, facilitate efficient insurance authorization, answer financial questions, and document authorization outcomes.
Manage uninsured and underinsured patient referrals for enrollment in available patient assistance and charity options.
Serve as a subject matter expert and operational resource to clinical leadership, providers, and prior authorization coordinators.