Medication Access Specialist - Home Infusion

Visante Consulting•Saint Paul, MN

4d•Remote

About The Position

The Medication Specialist’s responsibilities include the following : Reviewing medication authorizations submitted by clients Performing appropriate actions based on client and patient needs, including: Identifying the process to submit authorizations Reviewing documentation in the client’s medical record that is required for authorization submissions Performing benefits investigation reviews to determine patient coverage and out-of-pocket costs Identifying patient assistance programs, copay cards, grants, or funds that could be utilized to reduce patient financial burdens Communicating with the clinic to obtain additional information or guidance related to prior authorization submission Assisting clinics with submitting appeals related to coverage denials Communicates determinations and relevant follow-up with patients on behalf of clients, including: Sharing information related to medication coverage and financial assistance options Providing pharmacy options for where prescriptions can be filled Ensuring timely and accurate documentation related to services provided to clients and their patients by appropriately documenting information in clients’ EMR systems based on the agreed-upon Visante-client workflow and documenting information in Visante systems for tracking prior authorization volumes and associated fees Supporting clients with onboarding and training of client-employed medication access specialists, when directed and supporting Visante with continual process improvement and client-specific workflow and process development Collaborating with Visante team members and leaders to provide insight and constructive feedback into day-to-day operations Supporting clients with improving clinical staff and client pharmacy workflows and communications Completing other duties as assigned by the supervisor

Requirements

High school diploma or equivalent
3 years of experience working within healthcare or with pharmacy providers on medication access
State Board of Pharmacy Technician registration obtained within 6 months of hire
Demonstration of good judgment, multi-tasking and meeting deadlines with a sense of urgency, and being able to prioritize competing demands
Strong client relationship, interpersonal, and team skills
Proven ability to diagnose and resolve issues, demonstrating strong analytical and creative skills
Ability to make sound and timely decisions based on analysis, experience, and judgment
Clear and concise verbal and written communication skills and the ability to advise clients professionally and positively
Maintains confidentiality of all patient-related information
Excellent knowledge of medication reimbursement and healthcare prior authorization/coding
Excellent knowledge and proficiency in MS Word, Outlook, PowerPoint, and Excel

Nice To Haves

Previous consulting and/or client-facing experience
Experience with electronic medical record documentation and prior authorization workflows
Experience with performing retail pharmacy PBM adjudication
Experience in utilizing CoverMyMeds® to submit prior authorizations
Two (2) years of experience in healthcare revenue cycle that includes medication authorizations
Knowledge of CPT and ICD coding is highly desired
Knowledge of Medicare and third-party payer regulations and guidelines is highly desired
Two (2) years of experience in preadmission/precertification
Active CPhT certification through either PTCB or NHA

Responsibilities

Reviewing medication authorizations submitted by clients
Performing appropriate actions based on client and patient needs
Identifying the process to submit authorizations
Reviewing documentation in the client’s medical record that is required for authorization submissions
Performing benefits investigation reviews to determine patient coverage and out-of-pocket costs
Identifying patient assistance programs, copay cards, grants, or funds that could be utilized to reduce patient financial burdens
Communicating with the clinic to obtain additional information or guidance related to prior authorization submission
Assisting clinics with submitting appeals related to coverage denials
Communicates determinations and relevant follow-up with patients on behalf of clients
Sharing information related to medication coverage and financial assistance options
Providing pharmacy options for where prescriptions can be filled
Ensuring timely and accurate documentation related to services provided to clients and their patients by appropriately documenting information in clients’ EMR systems based on the agreed-upon Visante-client workflow and documenting information in Visante systems for tracking prior authorization volumes and associated fees
Supporting clients with onboarding and training of client-employed medication access specialists, when directed and supporting Visante with continual process improvement and client-specific workflow and process development
Collaborating with Visante team members and leaders to provide insight and constructive feedback into day-to-day operations
Supporting clients with improving clinical staff and client pharmacy workflows and communications
Completing other duties as assigned by the supervisor