Medication Access Specialist

Beth Israel Lahey Health•Westwood, MA

About The Position

The Medication Access Specialist will fulfill all job responsibilities as needed and coordinate for at least one or more specialty clinics. This position acts as a care coordination specialist between specialty/retail pharmacy and prescribers, responsible for documenting, submitting, communicating outcomes, and appealing all pharmacy and medical buy and bill prior authorizations. The role involves all aspects of obtaining patient access to prescribed medications, including benefit investigation, white bagging, financial assistance (grants/foundations/copay cards), and managing the Employee Variable Co-Pay Program. The specialist serves as a subject matter expert for physicians, administrators, clinical staff, pharmacy staff, and third-party payers regarding prior authorization approvals, ambulatory infusion reimbursement, and Patient Assistance programs. Key duties include collecting and reviewing data for prior authorization, providing formulary assistance, obtaining insurance authorizations for infusion medications, facilitating patient enrollment in programs, and managing the Employee Variable Co-Pay Program. The specialist also assists patients with financial assistance, provides exceptional customer service, serves as a direct patient and provider contact for pharmacy benefits information, coordinates services with various stakeholders, manages strategic initiatives, networks with payor and manufacturer contacts, and provides training and support to inter-departmental associates.

Requirements

High School diploma or GED required.
License Mass Registered Pharmacy Tech required.
Certificate 1 Certified Pharmacy Technician required.
3-5 years related work experience required in specialty pharmacy and medical prior authorization experience or a minimum of 4 years of pharmacy work experience.
Working knowledge of Common Procedural Terminology (CPT), Health Care Procedural Coding System (HCPCS) J Codes and International Classification of Diseases (ICD-10).
Experience with medical buy & bill and specialty clinic authorization management.
Must obtain PACS certification within twelve months of hire.
Experience with computer systems required, including web based applications and some Microsoft Office applications which may include Outlook, Word, Excel, PowerPoint or Access.

Nice To Haves

Prior lead or supervisor experience.
Familiarity with 340B drug program.
Deep knowledge of medication use in MS, RA, GI, transplant, hepatitis C, infectious disease (including HIV), and/or oncology a plus.
Advanced Certificate Pharmacy Technician credential (CPhT-Adv).

Responsibilities

Fulfill all job responsibilities as needed and coordinate for at least one or more specialty clinics.
Act as a care coordination specialist between specialty/retail pharmacy and the prescribers.
Document, submit, communicate outcomes and appeal all pharmacy and medical buy and bill prior authorizations.
Be involved in all aspects of obtaining patient access to prescribed medications such as benefit investigation, white bagging, financial assistance (grants/foundations/copay cards).
Manage the Employee Variable Co-Pay Program.
Serve as a subject matter expert for physicians, administrators, clinical staff, pharmacy staff, and third party payers for issues regarding prior authorization approvals, ambulatory infusion reimbursement and Patient Assistance programs.
Collect and review all data needed for pharmacy and medical prior authorization approvals.
Provide formulary assistance for clinic administered or infusion medications through evaluating necessity of prior authorization and identification of formulary alternatives.
Obtain initial and renewal insurance authorization for infusion medications as required by insurance plans and provide infusion cost estimates to patients or clinic staff.
Facilitate patient enrollment in available programs, handle customized communications, ensures ongoing claims processing accuracy and efficient delivery throughout the treatment period with a high-touch, member centric process and manages plan reporting.
Manage enrollment and services under the Employee Variable Co-Pay Program by reducing employee and plan sponsor costs and minimizing compliance risks.
Assist patients with various forms of financial assistance by serving as a patient advocate to communicate and coordinate with drug manufacturers, PBMs and dispensing pharmacies.
Provide exceptional customer service to internal and external customers; resolves any patient requests in a timely and accurate manner; escalates complaints accordingly; maintains frequent phone contact with patient, provider and pharmacy staff; and clarifies prescription orders with pharmacist and/or clinician as appropriate.
Serve as the direct patient and provider contact for pharmacy benefits information, clinical and program information.
Coordinate services with providers, specialty pharmacies and national account managers to improve turnaround time for patients.
Manage multiple strategic initiatives simultaneously and reprioritize where necessary, independently and effectively resolves complex accounts, and determines methods and procedures on new or special assignments with minimal supervision.
Network with key payor and manufacture contacts inside and outside own area of expertise.
Provide training and support to inter-departmental associates.
Cross cover other primary care and specialty clinics as needed.