Medication Access Specialist

Visante Consulting LLC•Saint Paul, MN

2d•Remote

About The Position

The Medication Access Specialist plays a vital role in Visante’s managed services team, working under the leadership team to streamline insurance processes, enhance medication access, and reduce financial burdens for patients. Acting as a liaison among pharmacies, clinic staff, and insurance providers, the specialist optimizes treatment initiation and improves patient satisfaction by handling medication authorizations, conducting benefits investigations, and identifying assistance programs. They gather prior authorization details, support coverage denial appeals, and communicate medication options and financial resources to patients while monitoring insurance status and reporting access issues to the treatment team. Emphasizing collaboration and efficiency, this position contributes to Visante’s mission of ensuring patients receive the medications they need.

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
Demonstrate strong judgment and decision-making, effectively managing competing demands while prioritizing tasks and meeting deadlines with urgency.
Cultivates strong client relationships, exhibiting excellent interpersonal and team collaboration skills while communicating professionally and concisely in both verbal and written forms.
Possesses extensive expertise in medication reimbursement, prior authorization, and healthcare coding, utilizing analytical and creative problem-solving abilities to diagnose and resolve issues.
Maintains confidentiality and ensures accuracy, leveraging proficiency in Office Suite (Word, Excel, PowerPoint) to analyze and disseminate critical information effectively.

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

Review and process medication authorizations submitted by the client.
Conduct benefits investigations to determine patient coverage, out-of-pocket costs, and available financial assistance.
Identify and recommend patient assistance programs, copay cards, grants, or funds to reduce financial burdens.
Gather and review necessary documentation for prior authorization submissions, assisting clinics with appeals for coverage denials.
Communicate directly with clinics to obtain additional details and guidance on authorization processes.
Inform patients about medication coverage and financial assistance options, providing pharmacy recommendations.
Ensure accurate documentation in client EMR systems and Visante tracking tools for workflow efficiency.
Assist with onboarding and training of client-employed medication access specialists and contribute to process improvements.
Collaborate with Visante team members and leadership to enhance operational effectiveness and implement recommended improvements.
Support efforts to refine clinical and pharmacy workflows, strengthening communication between staff and patients.