MEDICATION ACCESS SPECIALIST I, FHP - PHARMACY-MPA (3014776002)

Froedtert Health•MENOMONEE FALLS, WI

13d•Hybrid

About The Position

The Medication Access Specialist is a member of the Pharmacy Department team responsible for helping ensure patients’ financial access to medications throughout the continuum of care. The specialist serves as a liaison among patients, physician offices, pharmacies, insurance providers, foundations, manufacturers, and other parties to obtain medication coverage or financial assistance and to initiate and resolve appeals as needed. The role includes gathering medication insurance coverage and benefit information, obtaining medication authorizations, monitoring insurance status, helping facilitate medication refill requests, and communicating insurance issues to the treatment team. The specialist reviews electronic medical records for information needed to submit and resolve prior authorizations and refill requests, helps obtain updated prescription authorizations, and assists physician offices with required documentation. The specialist follows up with relevant parties and communicates authorization and refill outcomes using appropriate channels, including phone, in-basket messaging, and the electronic medical record. The position requires effective communication, problem-solving, time management, attention to detail, and the ability to handle multiple responsibilities in a team environment. The role is hybrid and based at the Integrated Service Center in Menomonee Falls, Wisconsin.

Requirements

At least 3 years of experience in pharmacy, healthcare, managed care, or another health insurance environment.
Knowledge of health insurance and pharmacy insurance benefit verification, health insurance terminology, billing, managed care contracting, hospital reimbursement, and hospital admitting and registration practices.
High school diploma or equivalent.
Proven attention to detail.
Experience with third-party insurance and medication or copay assistance programs.
Effective interpersonal skills, including the ability to develop collaborative alliances, promote teamwork, and support a high degree of internal and external customer satisfaction.
Strong organizational and follow-up skills.
Experience using computer systems and programs such as EPIC, insurance portals, or McKesson Enterprise.
Ability to learn quickly, work independently, and take programmatic initiative.
Ability to function in a fast-paced, changing environment and balance multiple priorities.
Experience navigating an electronic health record.
Application for Wisconsin registration as a Pharmacy Technician by the hire date, with registration obtained within 12 months of hire.
Pharmacy Technician Certification Board or National Healthcare Association (ExCPT) certification within the first 6 months of hire.

Nice To Haves

Four-year degree.
Graduation from an ASHP-accredited pharmacy technician training program.

Responsibilities

Serve as a liaison among patients, physician offices, pharmacies, insurance providers, foundations, manufacturers, and other parties to address medication access needs.
Initiate and resolve appeals as needed.
Obtain medication insurance coverage, assistance, and benefit information, as well as medication authorizations.
Monitor patients’ insurance status and assist with facilitating medication refill requests.
Communicate insurance issues to the treatment team.
Review electronic medical records for information needed to submit, appeal, and resolve prior authorizations and medication refill requests.
Assist in obtaining updated prescription authorizations for existing patients.
Assist physician offices with obtaining and completing documentation required for prior authorization and medication refill requests.
Communicate authorization and refill responses and outcomes to patients, physician offices, and other necessary parties through appropriate channels.
Follow up with physician offices and other necessary parties about the status of prior authorization and medication refill requests.
Read, interpret, and communicate information from insurance documents, electronic medical records, and patient charts.
Communicate effectively in writing and verbally through electronic health records, in-basket messages, phone calls, email, and other methods.
Problem-solve in a timely manner and determine when tasks should be handed off.
Manage tasks and responsibilities effectively, maintain attention to detail, and multitask efficiently.
Work collaboratively with a team and perform other duties as assigned.