Medication Access & Adherence Specialist

Piedmont HealthCare PA•Statesville, NC

3d•Hybrid

About The Position

The Medication Access & Adherence Specialist plays a dual role in supporting timely medication access and improving patient health outcomes. This specialist is responsible for managing prior authorization (PA) processes while proactively engaging patients to promote medication adherence through outreach, education and follow-up.

Requirements

2+ years of experience in prior authorization, healthcare support, pharmacy, or patient outreach
Knowledge of insurance processes, formularies, and medication access workflows
Strong communication and interpersonal skills, especially over the phone
Experience with EMR/EHR systems and pharmacy platforms
Ability to manage multiple tasks and work in a fast-paced environment
Demonstrated skills in leadership, advocacy, and communication.
Culturally effective capabilities demonstrating a sensitivity and responsiveness to varying cultural characteristics and beliefs.
Self-motivated, dependable, strong work ethic with a desire to learn.
Strong time and project management skills.
Experience with computer applications with proficient excel abilities.
Ability to apply critical thinking skills and make sound judgments both while performing daily responsibilities and throughout the patient’s continuum of care.
Knowledge and demonstrated abilities to work in a regulatory climate that includes oversight by federal and state rules, payer contracts, governmental benefits, and community resources.
Excellent oral and written communication skills.
Excellent interpersonal skills reflecting clarity and diplomacy and the ability to communicate accurately and effectively with all levels of staff and management.
Detail-oriented, thorough, and able to handle multiple tasks and projects with varying deadlines and priorities.
Ability to work successfully in a fast-paced, stressful environment.
Ability to work with a registry and an electronic health record.
Empathy, mental alertness, precision, analytical problem-solving abilities, communication skills, focus, and initiative.
Fundamental knowledge of healthcare organization, operations, and processes.
Ability to lead, organize, and collaboratively work with a team to ensure department goals are met in a timely manner.

Nice To Haves

Experience with HEDIS quality measures is preferred.
Experience in a clinical setting preferred

Responsibilities

Review, prepare, and submit prior authorization requests to insurance providers for prescribed medications
Track authorization status and ensure timely follow-up to prevent delays in therapy
Maintain accurate documentation of all PA activities in the appropriate systems
Identify alternative therapies or solutions when coverage barriers arise
Conduct outbound calls to patients to support medication adherence and persistence
Educate patients on proper medication use as directed by provider and importance of adherence
Identify barriers to adherence (cost, access, side effects, understanding) and provide solutions or escalate as needed
Coordinate refills and reminders to ensure continuity of care
Serve as a liaison between patients, providers, pharmacies, and insurance companies
Assist with benefits investigation and financial assistance programs when applicable
Support care teams with insights on patient adherence trends and access issues
Attend and participate in organized functions of PHC and perform administrative duties as necessary.
Other duties as assigned