Medication Access Coordinator - Specialty Pharmacy

TriHealth • Norwood, OH

2d • Onsite

About The Position

At TriHealth Specialty Pharmacy, Medication Access Coordinators play a critical
role in ensuring patients receive timely, affordable access to specialty
medications. In this position, you’ll go beyond traditional pharmacy tasks to
become an advocate for patients—navigating insurance benefits, prior
authorizations, appeals, and financial assistance programs that directly impact
patients’ ability to start and stay on therapy.

Working closely with clinical pharmacists, providers, and the dispensing team,
you’ll be part of a collaborative, mission‑driven environment where attention to
detail, empathy, and follow‑through truly matter. TriHealth values integrity,
confidentiality, and professionalism, and provides a supportive setting where
experienced pharmacy technicians can use their skills to improve the patient
experience while contributing to the success and growth of specialty pharmacy
services.

If you enjoy problem‑solving, working with insurance and benefits, and making a
meaningful difference for patients with complex medication needs, this role
offers long‑term stability, professional respect, and the opportunity to grow
your impact within a trusted health system.

Under the direction of the Specialty Pharmacy Clinical Manager and in
collaboration with the Clinical Pharmacists and Dispensing Team, the Specialty
Pharmacy Medication Access Coordinator (MAC) will coordinate medication access
and financial assistance for TriHealth specialty pharmacy patients.   This
includes performing pharmacy insurance benefit investigations; completing
specialty pharmacy prior authorizations (PAs); coordinating specialty
prescription drug appeals; coordinating specialty medication financial
assistance enrollment (copay cards, patient assistance programs, etc.) for
eligible patients; assisting in the miscellaneous coordination and follow up
with providers and clinical pharmacists and dispensing team to ensure timely
access to specialty medication therapy.    The MAC improves the patient
experience and maximizes pharmacy revenue.

Requirements

• Graduate of an approved technical, professional or vocational program or Bachelor's Degree, Associates Degree.
• Equivalent experience accepted in lieu of degree (minimum of 3.5 years of pharmacy technician experience required)
• 2-3 years’ experience Retail Pharmacy or Specialty Pharmacy or work experience in insurance verification, benefits, and eligibility investigations.
• Current national Pharmacy Technician Certification (CPhT) is required.  The current approved examinations are the Pharmacy Technician Certification Board (PTCB) or ExCPT Certification by the National Health career Association.
• Active registration with the Ohio Board of Pharmacy as a Certified Pharmacy Technician.
• Organized, high-integrity, attention to detail, dependable, quality focus, empathetic, good listener/communicator.
• Discretion and confidentiality essential as position deals with highly sensitive and private data.

Nice To Haves

• Knowledge of medical and pharmaceutical terminology and pharmaceutical patient assistance programs.
• Demonstrated experience in customer service with strong interpersonal and communication skills.

Responsibilities

• Develops and maintains strong relationships with physicians, prescribers, nurses, and patients to build the service. Provides caring service, adjusting approaches to reflect cultural differences of population served. Professionally and compassionately manages and resolves difficult situations involving patients. Responds politely and professionally to pharmacist/nursing/physician/patient or other requests via telephone, in writing, or in person.   Appropriately manages, triages, and ensures timely follow-up of all requests.   Clearly articulates ideas and thoughts through written and verbal communications.
• Benefit Investigation & Prior Authorization (PA):Pulls new prescriptions from the queue. Verifies that the pharmacy has patient’s current pharmacy insurance coverage information.  Tracks down missing information. Completes required  PA paperwork. Manage incoming calls, faxes and ePAs related to pharmacy prior authorizations. Ensures that the PA is approved and re-adjudicates prescription revealing patient’s financial responsibility. Documents PA renewal terms and schedule applicable reminders. Calls patient to inform them what they are responsible for paying. Patient Assistance Program (PAP):  Refers to the specialty list of manufacturer-sponsored assistance programs and suggest options for patient as applicable. Enrolls patient in Health System or Specialty payment plan or send to Patient Accounts (dependent on system). Document PAP renewal terms and schedule applicable reminders. Other Duties: When PA and PAPs are complete, communicates with patient and respective team members  to fill the prescription(s).  Refers cases requiring clinical review to a Pharmacist or Medical Provider.  Provides resolution to grievances and appeals issues.  Ensures that patients remain on track with medication regimens, medication adherence check-ups, and secures refill prescriptions. Communicates effectively with the clinical pharmacists and dispensing team. Answers patient questions about the service, insurance issues, etc. in a timely and accurately manner Provides customer service to patients by conducting inbound and outbound calls to schedule delivery of medications. Tracks packages to ensure patient receives medication in a timely manner.
• Facilitate adherence to medications by ensuring that patients receive prescribed medications in a timely manner.  Develops and maintains positive customer relations and coordinates with various functions within TriHealth to ensure customer requests and questions are handled appropriately and in a timely manner.   Enters and maintains accurate prior authorization and patient assistance program records.   Completes all necessary paperwork, forms, records, and electronic documentation according to policy and procedures and regulations.  Ensures compliance with regulatory requirements and organizational policies and procedures.  Collaborate and act as liaison with patient, family, and clinical pharmacists and dispensing pharmacy team.
• Performs full benefits verification on patients, including contacting payers to investigate and verify the terms and benefits of patient's insurance policies as well as patient cost. Provide thorough, accurate and timely responses to requests from pharmacy operations and/or patients regarding benefit information.   Assesses and establishes whether patient needs co-pay assistance.   Provides guidance to healthcare providers and patients in connection with documentation required for payer coverage, support with appeals for denied claims, and follow up with payer to determine outcome.
• Assists to ensure that electronically adjudicated claims reconciled and paid for prior to delivery.   Follows up on all unpaid claims and aging A/R items.   With Pharmacy Leadership,  participates in Third Party, Medicare, and Medical Provider claim audits in order to minimize financial exposure.
• Evaluates and escalates “at risk” accounts to Pharmacy Leadership for review for financial exposure or write off.   Documents and submits requests for Patient Refunds when appropriate.  Manages time effectively by proactively prioritizing daily tasks, issue resolution, and work requests.

Benefits

• We offer competitive shift differentials, opportunities for professional growth, and a comprehensive benefits package that may include medical, dental, vision, paid time off, retirement savings plans, and tuition reimbursement.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Associate degree
• Number of Employees: 1,001-5,000 employees