Medication Access Specialist

Thedacare•Appleton, WI

5d•Onsite

About The Position

The Medication Access Specialist is a member of the Pharmacy Department who helps ensure patients can obtain and afford medications throughout their care. The specialist serves as a liaison among patients, physician offices, pharmacies, insurers, foundations, manufacturers, and other parties to resolve coverage issues and arrange prescription assistance. The role gathers insurance and benefit information, handles medication authorizations, monitors insurance status, supports refill requests, and communicates insurance-related issues to the treatment team. The specialist reviews electronic medical records and patient charts to gather information for prior authorizations, appeals, and refill requests; coordinates required documentation with physician offices; communicates responses and outcomes; and follows up on pending requests. The role also supports coverage determinations, responds to pharmacy-related inquiries, provides customer service, addresses customer concerns, and works collaboratively to meet patient-focused department goals. This is a 40-hour-per-week, day-shift position based at ThedaCare Corporate in Appleton, Wisconsin.

Requirements

At least 3 years of experience in pharmacy, healthcare, managed care, or another health insurance environment.
Knowledge of health insurance and pharmacy insurance benefit verification, health insurance terminology, billing, managed care contracting, hospital reimbursement, and hospital admitting and registration practices.
High school diploma or equivalent.
Proven attention to detail.
Experience with third-party insurance and medication or copay assistance programs.
Effective interpersonal skills, including the ability to develop collaborative alliances, promote teamwork, and support customer satisfaction.
Strong organizational and follow-up skills.
Experience using computer systems and programs, such as EPIC, insurance portals, and McKesson Enterprise.
Ability to learn quickly, work independently, and take programmatic initiative.
Ability to work in a fast-paced, changing environment and balance multiple priorities.
Experience navigating an electronic health record.
Pharmacy Technician Certification Board or National Healthcare Association (ExCPT) certification required within the first 6 months of hire.
Ability to support and advance ThedaCare's mission and vision and demonstrate its guiding principles.

Nice To Haves

Four-year degree preferred.
Graduate of an ASHP-accredited pharmacy technician training program preferred.

Responsibilities

Review electronic medical records for information needed to submit, appeal, and resolve prior authorizations and medication refill requests.
Assist in obtaining updated prescription authorizations for existing patients.
Help physician offices obtain and complete documentation needed for prior authorization and medication refill requests.
Communicate responses and outcomes of prior authorizations and refill requests to patients, physician offices, and other necessary parties through appropriate channels.
Follow up with physician offices and other necessary parties regarding the status of prior authorization and refill requests.
Read, interpret, and communicate information from insurance documents, electronic medical records, and patient charts.
Communicate effectively in writing and verbally through electronic health records, in-basket messages, phone calls, email, and other methods.
Collaborate with internal and external customers to respond to and resolve pharmacy-related inquiries from patients, providers, and pharmacists.
Participate in coverage determinations, including certification, prior authorization, and exceptions to coverage, by reviewing requests approvable under clinical criteria.
Provide a high level of customer service to internal and external customers.
Lead service recovery efforts in the assigned area when needed.
Work to resolve customer concerns and manage difficult situations to promote customer satisfaction.
Work with the department and individual groups toward shared goals and service to patients.
Problem-solve in a timely manner, manage time effectively, and recognize when tasks should be handed off.
Handle multiple tasks with attention to detail and work effectively in a team environment.
Perform other duties as assigned.