Medication Access Coordinator I

Job Summary

Accountable to obtain prior authorization for medications. Complete benefit investigation to determine coverage for prescribed treatment and act as a liaison for all medication prior authorization matters to insurance companies, departments, and patients. Act as subject matter expert for patient medication assistance foundations, free drug and drug replacement programs for uninsured, under-insured, indigent population. Maintains updated knowledge of pharmacy reimbursement methodologies.

Job Duties

• Completes prior authorization and documents referrals for all medications reviewed using appropriate third-party payer criteria.
• Conducts research and follow-up activities within established timeframes.
• Maintains knowledge of criteria changes of third-party payor authorization requirements.
• Communicates with care team to provide details on authorization status.
• Maintains knowledge of all available patient assistance programs and eligibility requirements.
• Identifies available appropriate medication assistance programs upon discussing with patient the affordability of the prescribed treatment.
• Ensures accurate completion necessary signatures of appropriate paperwork for enrollment in assistance program(s).
• Tracks fund award end dates and exhaustion, re-apply as necessary to avoid lapse in therapies.
• Communicates with care team to provide details on status of assistance applications.
• Educate providers and patients on specialty services and how this improves overall patient care.
• Grow the specialty pharmacy's patient population.
• Floats from areas of low workload to areas of heavy workload as needed to provide optional patient services.
• Accountable for satisfying all job specific obligations and complying with all organization policies and procedures.

Work is typically performed in an office environment. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job. Relevant experience may be a combination of related work experience and degree obtained (Associate's Degree = 2 years; Bachelor's Degree = 4 years).

Education

• High School Diploma or Equivalent (GED) - Required

Experience

• Minimum of 6 years - Relevant experience* (Required)

Certification(s) and License(s)

Certification(s) and License(s)

Benefits

We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners. Perhaps just as important, from senior management on down, we encourage an atmosphere of collaboration, cooperation and collegiality.