Medication Access Specialist

Thedacare • Appleton, WI

9d • Onsite

About The Position

The Medication Access Specialist is a dedicated member of the Pharmacy Department team responsible for assuring the financial viability of patients as they flow through the continuum of care. This role acts as a liaison between patients, physician offices, pharmacies, insurance providers, and other third parties to initiate and resolve appeals. The specialist also works with patients, foundations, manufacturers, or other necessary parties to obtain financial prescription assistance for patients in need. Key responsibilities include obtaining medication insurance coverage or assistance and benefit information, securing authorizations for medications, monitoring patient's insurance status, assisting with medication refill requests, and communicating insurance issues to the treatment team.

Requirements

• 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, health insurance terminology, billing, managed care contracting, hospital reimbursement, and 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.
• Certification through Pharmacy Technician Certification Board or National Healthcare Association (ExCPT) Required within the first 6 months of hire.
• Ability to support, advance and live our mission and evidence of such: Mission – Our reason for Being - To advance the health of our communities through excellence and discovery, inspiring each person to live their unique best life
• Ability to support, advance and work toward our vision and evidence of such. Vision - Who we Aspire to be - To be your trusted partner, transforming health care for everyone every day
• Commitment to and evidence of demonstrating our guiding principles.

Nice To Haves

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

Responsibilities

• 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 (include 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.)
• Collaborates with both internal and external customers in responding to and resolving pharmacy-related inquiries from patients, providers, or pharmacists
• Participates in the coverage determination (certification, prior authorization, Exception to coverage, etc.) process by reviewing all requests which are approvable based on clinical criteria.
• Provides a high level of customer service to all internal and external customers.
• Leads service recovery efforts in respective area if needed.
• Actively works to resolve customer concerns and manages difficult situations to promote a high level of customer satisfaction.
• Works within the department and individual groups to maintain a focus on common goals and service to the end customer (the patient).
• Problem solves as needed within a timely manner
• Effective time management of tasks and responsibilities.
• The ability to discern when it is appropriate to hand off tasks
• Detail oriented with ability to effectively and efficiently multi-task.
• Ability to work in a team environment.
• Other duties as assigned.

Benefits

• Lifestyle Engagement e.g. health coaches, relaxation rooms, health focused apps (Wonder, Ripple), mental health support
• Access & Affordability e.g. minimal or zero copays, team member cost sharing premiums, daycare

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 501-1,000 employees