Pharmacy Technician Specialist-Specialty Pharmacy Medication Access

Pharmacy Technician Specialist—Specialty Pharmacy Medication Access (Full-time Days)

At Northwestern Medicine, every patient interaction makes a difference in cultivating a positive workplace. This patient‑first approach is what sets us apart as a leader in the healthcare industry. As an integral part of our team, you'll have the opportunity to join our quest for better health care, no matter where you work within the Northwestern Medicine system. We pride ourselves on providing competitive benefits: from tuition reimbursement and loan forgiveness to 401(k) matching and lifecycle benefits.

The Pharmacy Technician Specialist reflects the mission, vision, and values of NM, adheres to the organization's Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and other regulatory and accreditation standards.

• Identify, research, and resolve consumer complaints.
• Check incoming prescriptions for completeness of all required information.
• Possess working knowledge of participating third‑party payors and their requirements.
• Establish and maintain open communication with pharmacy operations analysts regarding third‑party billing issues and the centralized procurement team regarding ordering and inventory matters.
• Assist with prescription audits as needed.
• Educate pharmacy staff regarding third‑party billing policies and procedures as needed.
• Answer and triage patient, provider, and third‑party calls to appropriate individuals adhering to phone scripts in a courteous and professional manner.
• Contact payers for lost medication, replacement, or vacation overrides.
• Troubleshoot and resolve billing rejections and rebill claims to carriers for all commercial, federal, and state insurance plans.
• Verify and accurately update patient demographic information in appropriate system(s).
• Document patient's insurance information in appropriate system(s).
• Refer and document any clinical questions regarding prescriptions, drug information, or health conditions requiring follow‑up to a pharmacist.
• Utilize case management and pharmacy software systems to schedule prescription refills and adjudicate claims.
• Coordinate prescription orders accurately and appropriately, including, but not limited to, “ready at” date, time, and shipping/delivery method.
• Perform point‑of‑sale functions.
• Understand and adhere to drug‑specific REMS requirements and identify what is needed for REMS fulfillment. Complete any REMS forms and authorizations required from the pharmacy. Print drug‑specific medication guides to be dispensed when needed.
• Complete prescription return‑to‑stock reports in a timely manner to meet compliance requirements.
• Access, input, and retrieve information on the pharmacy computer system to create labels for prescriptions.
• Possess thorough understanding of the processes and procedures for shipping patient’s medications and can independently resolve any complications.
• Spend ≤ 5 % of time on quality management of the program.
• Support the Northwestern Medicine Ambulatory Pharmacy team to enhance workflow for clinical pharmacy services throughout the network.
• Responsible for providing access to medications for patients by completing Prior Authorization Requests, co‑pay assistance programs, medication assistance programs, and benefits investigation.
• Coordinate with third‑party insurance, clinical staff, and patients to effectively process prior authorization requests for medications within the prescribed timelines.
• Directly enroll eligible patients into manufacturer patient assistance co‑pay programs.

• Initiate and facilitate all drug purchasing for the pharmacy department.
• Monitor stock levels; evaluate previous purchasing and utilization patterns and anticipate needs.
• Maintain appropriate drug inventories.
• Coordinate the receipt of all deliveries, restock storage areas and rotate stock as necessary.
• Develop and maintain sources and mechanisms to obtain drug supplies on an emergency basis interacting with local hospitals, pharmacies, alternative vendors, etc.
• Facilitate all returns and credits of…