Pharmacy Medication Access Specialist - Full time

Overview

Job Summary:

Primarily responsible for assisting with all aspects of medication access, including but not limited to collaboration with healthcare teammates, communication with patients, addressing and resolving medication-related needs, completing necessary reporting and/or auditing, and conducting and completing necessary third party (insurance) requests, as applicable.

Essential Functions:

Navigates various options for receiving prior authorization requests and further utilizing systems to find resources that best fit the patient's needs, as applicable.

Provides assistance to a subset of patients by completing Patient Assistance Program (PAP) applications and co-pay assistance applications.

Assists patients by explaining the medication access process, which may include completing applications and reviewing documents required to complete the application.

In collaboration with pharmacists, completes medication reconciliation, reviews prescription claim history for medication adherence and documents findings in the electronic health record, as applicable. Also available to patients and families to triage questions regarding medication access needs.

Verifies patient insurance benefits to minimize patient cost.

Completes PAP and copay assistance applications, records qualitative monthly/quarterly feedback, refill reminders and medication shipment scheduling, and patient re-enrollment in appropriate assistance programs, as appropriate.

Apply co-pay assistance payments to the appropriate patient account, as applicable.

Performs data entry and prepares tracking reports for both internal and external stakeholders.

Garners and maintains knowledge of Health Plan compliance requirements, healthcare operations, and medical terminology.

Efficiently determines a patient's ability to utilize enterprise pharmacy services. Routes prescriptions to appropriate pharmacy, as necessary.

Supports the development of methods of communication and coordination with patient care team to ensure timely and accurate fulfillment of orders for patient requests and clients.

Maintains updated knowledge and skills and contributes to the education of others.

Participates in planning processes by establishing personal goals to support quality improvement efforts and contributes to the achievement of departmental objectives.

Audits own performance and recommends objectives and standards of performance.

Contributes positively to execution of pharmacy department initiatives.

Accepts assignments of tasks from other pharmacy teammate roles when workload dictates.

Job requirements:

High school diploma required or GED equivalent.

Registration with state board of pharmacy per state of employment requirements.

Certification through Pharmacy Technician Certification Board (CPhT) or National Healthcareer Association (ExCPT).

Associate or Bachelor's degree preferred.

PTCB Billing and reimbursement certificate or similar certification preferred.

Three (3) years pharmacy experience or hospital/helathcare/medical group experience preferred.

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