Medication Access Specialist

CLS Health PLLC•Webster, TX

About The Position

CLS Health is a growing, physician-led healthcare system in Houston, Texas, providing holistic, multispecialty care. The Medication Access Specialist owns the end-to-end access process for specialty and infused medications across the infusion center and pharmacy. The role ensures medications progress from order to first treatment without gaps by coordinating coverage, authorizations, financial assistance, sourcing, and treatment scheduling.

Requirements

At least 3 years of experience in medication access, prior authorization, or specialty pharmacy intake; experience in an infusion or specialty clinic setting is preferred.
Working knowledge of J-codes, biosimilars, buy and bill, specialty pharmacy, and medical versus pharmacy benefits.
Hands-on experience with copay assistance portals, manufacturer hub programs, and PAP applications.
Familiarity with major commercial, Medicare Advantage, and Medicaid payer policies for specialty drugs.
Strong organization and follow-through, with the ability to manage a high volume of open cases.

Nice To Haves

Pharmacy technician certification or similar qualification.

Responsibilities

Receive and review medication orders from referring providers.
Complete benefits investigations, determine whether coverage is through the medical or pharmacy benefit, and establish patient financial responsibility.
Determine medication routing through infusion-center buy-and-bill or a specialty pharmacy based on payer requirements.
Submit and track prior authorizations through payer and portal workflows, including coordinating appeals and peer-to-peer reviews.
Enroll patients in copay card programs, manufacturer portals, foundation assistance, and patient assistance programs (PAP) for free medication.
Coordinate medication sourcing with the pharmacy and distributor, and confirm product and biosimilar selection according to payer formulary.
Schedule initial treatments and hand off patients to clinical staff.
Track authorization expirations and coordinate reauthorizations.