Lead Pharmacy Ops - Access Specialist

Job Overview

The Lead Pharmacy Access Specialist is responsible for overseeing and streamlining patient access to essential medications within Fairview Pharmacy Services. This role involves managing complex payer policies, verifying insurance benefits, and removing barriers to care through collaboration with patients, payers, and clinical teams. The Lead Pharmacy Access Specialist also guides patients through financial assistance options, coordinates high-cost drug procurement, and serves as the primary escalation point for complex access issues.

Additionally, this position leads process improvement initiatives, maintains key relationships with stakeholders, and supports pharmacy staff through training and development. By fostering efficient, compassionate access to pharmacy services, the Lead Specialist ensures that patients receive timely, affordable care that meets their needs and supports positive health outcomes.

• Drive Process Improvement Initiatives:
  Identify and implement process improvements to streamline patient access workflows, reduce turnaround times, and increase efficiency in the authorization process.
• Serve as Escalation Point for Complex Cases:
  Provide guidance and solutions for challenging cases, including appeals for denied claims, coverage exceptions, and negotiating with third‑party payers.
• Identify and elevate issues if deemed beyond scope.
• Train and onboard new employees. Lead orientation and training for new staff members, ensuring they understand access protocols, payer policies, financial assistance resources, and best practices for patient support.
• Establish and Manage Key Stakeholder Relationships:
  Build and maintain relationships with payers, specialty pharmacies, manufacturers, and financial assistance organizations to facilitate patient access to medications.
• Optimize Financial Assistance Programs:
  Develop and implement strategies to maximize patient enrollment in financial assistance programs and identify additional resources.
• In partnership with the Pharmacy Leader and other stakeholders, provide workflow management of the day-to-day operations in assigned pharmacy and/or clinical service area, driving patient care excellence while ensuring achievement of organizational goals.
• Coordinates the daily workflow and solves issues which need resolution within a department, in a peer-to-peer relationship and as a liaison with leadership. The focus is to strengthen and enhance the work climate and workflow. The lead has a high level of technical expertise and displays role model competency in knowledge, communication and experience while acting as the primary peer resource.
• The Lead will skillfully use interpersonal, customer service, problem solving and collaboration skills to support and influence operational objectives. Proficient in their knowledge of responsibilities, the Lead will be capable of assisting and resolving exceptions commonly referred to the supervisor for resolution.

• Perform verification of insurance benefits, analysis, payer policies, identify any potential access issues, and removing barriers to care across Fairview Pharmacy Services.
• Assist in resolving access issues with payers and provide information and expertise to other departments.
• Assess patients’ payor source and clinical information to identify appropriate site to provide care for patient (home infusion, outpatient infusion therapy, or specialty pharmacy) and coordinate with staff as appropriate.
• Screen patients for financial assistance eligibility by gathering financial information including income, assets, and estimates of charges for service, as appropriate.
• Support pharmacy services with requests from revenue cycle (coding, billing, etc.)…