Pharmacy Medication Access Specialist II

FLSA Status

Non-Exempt

Job Role Summary

The Pharmacy Medication Access Specialist II is responsible for improving patient access to and ensures optimal reimbursement for medications and therapies administered and prescribed by Eskenazi Health with a focus on patient assistance and medical benefit precertification. This position functions as a liaison and navigator for patients, clinical staff, pharmacy department, payors, and programs to eliminate barriers to care. The Pharmacy Medication Access Specialist II uses a proactive approach to identifying patient insurance coverage and programs that affect costs for therapies with a focus on high cost, high reimbursement medications utilized in various specialty and primary care clinics.

Essential Functions and Responsibilities

•    Proactively contributes to Eskenazi Health’s mission: Advocate, Care, Teach and Serve with special emphasis on the vulnerable population of Marion County; models Eskenazi Health values of Professionalism, Respect, Innovation, Development and Excellence
•    Assists with responsibility for implementation, documentation and maintenance of Eskenazi Health’s Medication Access Program (MAP)
•    Contributes to maximizing revenue capture for high-cost clinic-administered and take-home medications by completing third party (external) medical benefit authorizations
•    Works to maximize Eskenazi Health and patient participation in pharmaceutical company sponsored medication assistance programs – institutional, individual and foundation-based
•    Continuously seeks new programs and opportunities for medication access
•    Develops a thorough understanding of reimbursement policies and patterns for pharmacy claims with third parties and resolves discrepancies
•    Communicates effectively with care teams and insurance companies as necessary to follow up on rejected claims, denials, or other barriers to therapy 
•    Triages, processes, and manages pharmacy prior authorization requests with diligent follow-up to patients and providers as appropriate
•    Pre-screens patients for viable payment sources and educates care teams on outcomes and processes necessary to achieve coverage
•    Analyzes payor responses and seeks available wraparound sources of support for patient therapy plans
•    Identifies pathways to coverage for uninsured and underinsured patients
•    Facilitates adherence by ensuring that patients receive prescribed medications and therapies in a timely manner
•    Ensures medications can be physically obtained by patients through a variety of modalities (delivery, home delivery, mail delivery, pickup, etc.)
•    Maintains multiple queues and portals, internal and external, that provide baseline functionality to operate medication access program (EHR, Prior Authorization request, Medicaid, specialty pharmacy, manufacturer, foundations, etc.)
•    Identifies opportunities to improve reimbursement optimization and works collaboratively to develop and institute successful action plans 
•    Works in collaboration with care teams (physicians, nurses, clinical specialists, pharmacists, social workers, precertification analysts) to ensure patients are adequately triaged and monitored throughout therapy
•    Trains or instructs staff members and peers on use of patient assistant programs and other programs or actions that affect the MAP
•    Provides ongoing feedback to staff resulting from MAP quality assurance audits
•    Collaborates with other care providers to promote a high standard of care
 

Job Requirements

•    Completion of a high school education or equivalent required
•    Bachelor’s degree required; a minimum of five years of relevant pharmacy experience may be accepted in lieu of degree
•    Two years of experience in program development or staff education preferred
•    Licenses/Certification required: Pharmacy Technician License, Pharmacy Intern License, or Technician in Training License in the State of Indiana
•    Successful completion of Eskenazi Health Pharmacy Technician Training Program within 122-day probationary period.
•    Participation in continuing education activities to meet licensure and certification requirements CPhT certification through the Pharmacy Technician Certification Board preferred
 

Knowledge, Skills & Abilities

•    Knowledge of medication reimbursement, healthcare insurance, and prior authorization/coding
•    Knowledge of and ability to use a variety of computer programs including database management, EHR, and spreadsheets
•    Strong oral and written communication skills
•    Ability to effectively manage conflicts and resolve problems
•    Strong interpersonal skills, including ability to effect collaborative alliances, promote teamwork, and ensure a high level of internal and external customer satisfaction
•    Ability to function effectively in fast-paced changing environment with multiple priorities
•    Strong critical thinking skills and ability to work independently, quickly and with initiative