Medication Access Coordinator

ThedaCare

About The Position

Summary : The Medication Access Coordinator is responsible for coordinating the efforts around prior authorizations for medications billed through patients' pharmacy & medical benefits, patient assistance workflows, ensuring accurate billing and reimbursement for pharmacy services, and around the prescription refill workflows and protocol maintenance. The position will operate as a liaison between the Medication Access team, clinic leadership, clinical staff, providers, insurance providers and other involved parties to provide safe and efficient care to all patients impacted by the medication access team. Remote access may be required for timely work completion due to the time sensitivity around these services. Responsible for oversight of obtaining medication insurance coverage or assistance and benefit information, authorizations of medications, monitors patient's insurance status, assists in facilitating medication refill requests, and communicates insurance issues to the treatment team. Coordinates the day-to-day functions on the Medication access team to ensure timeliness of all services and ensure proper follow up is done by team members. Responsible for providing updates around medication access services to physicians, clinical staff, and pharmacy office, through multiple methods as appropriate (includes in services, email communication, one on one meetings). Coordinate the research, design, and implementation of practices and processes for medication access services. Other duties as assigned.

Requirements

A minimum of 2 years’ experience as a Medication Access Specialist 2 (or similar experience).
Cross trained and demonstrated ability to support prior authorization services in a minimum of 3 different disease states and/or demonstrated ability to support multiple clinics from a medication refill perspective and/or demonstrated ability to support all areas in regards to foundation and manufacture assistance.
Cross trained and demonstrated competence in multiple medication access team responsibilities (such as prior authorizations, foundation and manufacture assistance, and medication refill support).
Experience with 3rd party insurance.
High school diploma or equivalent is required.
Proven attention to detail.
Exceptional customer service skills.
Proven ability to communicate effectively with a diverse group.
Outstanding organizational skills.
Promotion skills ability to sell a program.
Experience with various computer systems, programs, and insurance companies (such as EMR, retail pharmacy POS, web portals).
Ability to independently facilitate new projects and work with a multidisciplinary group to achieve success.
Aptitude for accomplishing goals with minimal supervision and working independently with efficiency and self-motivation.
Critical thinking skills to improve upon current processes and suggest solutions to problems with the services.
Application for Wisconsin registration as a Pharmacy Technician is required by hire date and must be obtained within 12 months of hire.
Certification as a Pharmacy Technician (CPhT) through passing the Pharmacy Technician Certification Boards exam (PTCE) or the National Health career Associations exam (ExCPT) is required within 6 months of hire.

Nice To Haves

None.
4-year degree preferred.
Graduate of ASHP accredited pharmacy tech training program preferred.
None.

Responsibilities

Collaborates with both internal and external customers in responding to and resolving pharmacy-related inquiries from patients, providers, or pharmacists
Participates in the coverage determination (certification, prior authorization, Exception to coverage, etc.) process by reviewing all requests which are approvable based on clinical criteria.
Provides complete and accurate documentation specifying the rational for approval, and forwarding to the appropriate healthcare provider/clinician.
Provide clinical expertise and support for commercial and government funded programs in the area of prior authorization, grievance, appeals and exceptions.
Maintains a thorough understanding of Medicare and Medicaid guidelines and stay abreast of updates and changes through a variety of educational opportunities
Demonstrates strong multitasking abilities to track and report utilization, practice patterns, and significant deviations for process improvement
Proactively identifies uninsured and under insured patients and facilitates the enrollment process into manufacture assistance &co-pay assistance programs while applying funds to patient accounts to ensure cost avoidance for the Organization and patient access to medication therapy.
Collaborates with pharmacists to review orders and related procedures/diagnoses to ensure the appropriateness and medical necessity of medication use based on established criteria
Verify the accuracy of patient insurance information in Electronic Health Record system by communicating directly with insurance companies and patient financial services (PFS)
Monitors medication receipt and dispensing of patients receiving medication through a co-pay assistance program or drug repository.
Review monthly Medicare and other insurance write-offs to determine the reasons for the write-offs.
Work with the Specialty Pharmacy Coordinator to implement proactive process to reduce and eventually eliminate write-offs.
Proactively involves and communicates with pharmacy and multidisciplinary teams to coordinate patient assistance
Documents in appropriate record keeping system in a timely and efficient manner to ensure appropriate record keeping and communication between collaborative teams.
Acts as a liaison between the pharmacy and other clinical units within the health system.
Develops and maintains positive relationships to promote the pharmacy medication services
Administers the expected level of competence and skill in healthcare insurance and assistance programs, exhibits professional behavior, and supports the mission of pharmacy practice excellence and education.
Influences situations around conflict/disagreement and demonstrates the ability to manages challenging situations in a manner to provide a quality experience
Accountable for managing patient assistance and medication benefits and providing exceptional patient care.
Prioritizes workload to meet patient and customer needs.
Maintains competency in their practice area.
Appropriately files and maintains pharmacy records in accordance with Wisconsin and Federal Law and departmental policy.
Manages and completes all required audits (as assigned)
Identifies quality improvement opportunities and provides constructive feedback.
Actively collaborates to implement improvements to assure the excellence of departmental services.
Represents the pharmacy department on committees, interdisciplinary groups, task forces and/or improvement teams as a pharmacy subject matter expert.
Demonstrates effective problem-solving skills.
Facilitates training fellow Medication Access Specialists and pharmacy extenders/learners in orientation to policies, procedures, and workflows
Educates pharmacy and other FH staff on policies and procedures related to billing, reimbursement, and compliance
Educates pharmacy and other FH staff regarding new and existing programs
Provides a high level of customer service to all internal and external customers.
Leads service recovery efforts in respective area if needed.
Actively works to resolve customer concerns and manages difficult situations to promote a high level of customer satisfaction.
Works within the department and individual groups to maintain a focus on common goals and service to the end customer (the patient).

Benefits

Lifestyle Engagement e.g. health coaches, relaxation rooms, health focused apps (Wonder, Ripple), mental health support
Access & Affordability e.g. minimal or zero copays, team member cost sharing premiums, daycare

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