Medication Access Specialist - Refill

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Location: US:

WI:

MENOMONEE FALLS at our INTEGRATED SERVICE CENTER facility.

Job Type: HYBRID

Sign‑on Bonus: $5,000

Shift Details: Monday - Friday working 8 AM - 4:30 PM, no weekends or holidays

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. Acts as the liaison between patient, physician office, pharmacy, insurance providers, and other third parties to initiate and resolve appeals, as needed. Acts as a liaison between patients, foundations, manufactures or necessary parties, to obtain financial prescription assistance for patients in need.

Responsible for obtaining medication insurance coverage or assistance and benefit information, authorizations of medications, monitoring patient insurance status, assisting in facilitating medication refill requests, and communicating insurance issues to the treatment team. Reviews electronic medical record for patients to collect any pertinent information needed to submit, appeal, and resolve prior authorizations and medication refill 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, and 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. Reads, interprets, and effectively communicates information from insurance documents, electronic medical records, and patient charts. Effectively participates in both written and verbal communication through multiple means (such as electronic health record, in-basket messages, phone calls, emails, etc.). Problem solves as needed within a timely manner.

Manages time effectively and discern when it is appropriate to hand off tasks. Detail oriented with ability to effectively and efficiently multi‑task. Works well in a team environment. Other duties as assigned.

A minimum of 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 registration practices is required.

High School diploma or equivalent is required. A 4‑year degree is preferred. Graduate of an ASHP accredited pharmacy tech training program is preferred.

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.

Application for Wisconsin registration as a Pharmacy Technician is required by hire date and must be obtained within 12 months of hire. Staff hired into this role prior to 3/31/23 must have applied for Wisconsin registration by 3/31/23 and have until 3/31/24 to obtain registration. Certification through the Pharmacy Technician Certification Board or National Healthcare Association (ExCPT) is required within the first 6 months of hire.