Medication Access Specialist

Froedtert • Menomonee Falls, WI

7d • Hybrid

About The Position

The Medication Access Specialist is a dedicated member of the Pharmacy Department team who is responsible for assuring the financial viability of patients as they flow through the continuum of care. Acts as the liaison between patient, physician office, pharmacy, insurance providers, and other third parties to initiate and resolve appeals, as needed. Acts as a liaison between patients, foundations, manufactures or necessary parties, to obtain financial prescription assistance for patients in need. Responsible for 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. Reviews electronic medical record for patients to collect any pertinent information needed to submit, appeal, and resolve prior authorizations and medication refills requests (such as diagnoses, past medical history, past prescription history, and other information). Assists in obtaining updated prescription authorization for existing patients. Assists the physician's office in obtaining and completing any and all documentation necessary to complete prior authorization and medication refill requests. Updates the patient, physician's office, any necessary parties through multiple methods as appropriate (including telephone, in-basket messaging, and electronic medical record), regarding responses and outcomes of prior authorizations and medication refills. Requires appropriate follow up with physician's office and any necessary parties in regards to status of prior authorizations and medication refill requests. Read, interpret, and effectively communicate information from insurance documents, electronic medical records, patient charts. Effectively participate in both written and verbal communication through multiple means (such as electronic health record, in basket messages, phone calls, emails, etc.). Problem solve as needed within a timely manner. Effective time management of tasks and responsibilities. The ability to discern when it is appropriate to hand off a task. Detail oriented with ability to effectively and efficiently multi-task. Ability to work in a team environment. Other duties as assigned.

Requirements

• A minimum of 3 years of experience in pharmacy, healthcare, managed care, or other health insurance environment is required.
• Knowledge of health insurance and pharmacy insurance benefit verification.
• Knowledge of health insurance terminology.
• Knowledge of billing.
• Knowledge of managed care contracting.
• Knowledge of hospital reimbursement.
• Knowledge of hospital admitting and registrations practices required.
• High School diploma or equivalent is required.
• Proven attention to detail.
• Experience with third party insurance and medication/co-pay assistance programs.
• Effective interpersonal skills, including the ability to develop collaborative alliances, promote teamwork and ensure a high degree of internal and external customer satisfaction.
• Outstanding organizational and follow-up skills.
• Experience with various computer systems and programs (such as EPIC, insurance portals, McKesson Enterprise, etc.).
• Quick learner.
• Ability to work independently and take programmatic initiative.
• Ability to function in a fast paced and changing environment and balance multiple priorities.
• Experience with navigating an Electronic Health Record.
• Application for Wisconsin registration as a Pharmacy Technician is required by hire date and must be obtained within 12 months of hire.
• Certification through Pharmacy Technician Certification Board or National Healthcare Association (ExCPT) required within the first 6 months of hire.

Nice To Haves

• 4 year degree preferred.
• Graduate of ASHP accredited pharmacy tech training program preferred.

Responsibilities

• Assure the financial viability of patients as they flow through the continuum of care.
• Act as the liaison between patient, physician office, pharmacy, insurance providers, and other third parties to initiate and resolve appeals.
• Act as a liaison between patients, foundations, manufactures or necessary parties, to obtain financial prescription assistance for patients in need.
• Obtain medication insurance coverage or assistance and benefit information.
• Obtain authorizations of medications.
• Monitor patient's insurance status.
• Assist in facilitating medication refill requests.
• Communicate insurance issues to the treatment team.
• Review electronic medical record for patients to collect pertinent information needed to submit, appeal, and resolve prior authorizations and medication refills requests.
• Assist in obtaining updated prescription authorization for existing patients.
• Assist the physician's office in obtaining and completing necessary documentation for prior authorization and medication refill requests.
• Update the patient, physician's office, and any necessary parties regarding responses and outcomes of prior authorizations and medication refills.
• Follow up with physician's office and any necessary parties regarding the status of prior authorizations and medication refill requests.
• Read, interpret, and effectively communicate information from insurance documents, electronic medical records, and patient charts.
• Participate in written and verbal communication through multiple means.
• Problem solve as needed within a timely manner.
• Manage time effectively for tasks and responsibilities.
• Discern when it is appropriate to hand off a task.
• Multi-task effectively and efficiently.
• Work in a team environment.

Benefits

• Paid time off
• Growth opportunity- Career Pathways & Career Tuition Assistance, CEU opportunities
• Academic Partnership with the Medical College of Wisconsin
• Referral bonuses
• Retirement plan - 403b
• Medical, Dental, Vision, Life Insurance, Short & Long Term Disability, Free Workplace Clinics
• Employee Assistance Programs, Adoption Assistance, Healthy Contributions, Care@Work, Moving Assistance, Discounts on gym memberships, travel and other work life benefits available

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED