Medication Access Coordinator - Specialty Pharmacy

About the role

At TriHealth Specialty Pharmacy, Medication Access Coordinators play a critical role in ensuring patients receive timely, affordable access to specialty medications. In this position, you'll go beyond traditional pharmacy tasks to become an advocate for patients—navigating insurance benefits, prior authorizations, appeals, and financial assistance programs.

Responsibilities

• Develops and maintains strong relationships with physicians, prescribers, nurses, and patients to build the service.
• Provides caring service, adjusting approaches to reflect cultural differences of population served.
• Manages and resolves difficult situations involving patients.
• Responds politely and professionally to pharmacist/nursing/physician/patient or other requests via telephone, in writing, or in person.
• Clearly articulates ideas and thoughts through written and verbal communications.
• Benefit Investigation & Prior Authorization (PA):
  • Pulls new prescriptions from the queue.
  • Verifies that the pharmacy has patient’s current pharmacy insurance coverage information.
  • Tracks down missing information.
  • Completes required PA paperwork.
  • Manage incoming calls, faxes and ePAs related to pharmacy prior authorizations.
  • Ensures that the PA is approved and re-adjudicates prescription revealing patient’s financial responsibility.
  • Documents PA renewal terms and schedule applicable reminders.
  • Calls patient to inform them what they are responsible for paying.
• Patient Assistance Program (PAP):
  • Refers to the specialty list of manufacturer-sponsored assistance programs and suggests options for patients as applicable.
  • Enrolls patient in Health System or Specialty payment plan or sends to Patient Accounts (dependent on system).
  • Documents PAP renewal terms and schedule applicable reminders.
• Other Duties:
  • Communicates with patient and respective team members to fill the prescription(s).
  • Refers cases requiring clinical review to a pharmacist or Medical Provider.
  • Provides resolution to grievances and appeals issues.
  • Ensures that patients remain on track with medication regimens, medication adherence check-ups, and secures refill prescriptions.
  • Communicates effectively with the clinical pharmacists and dispensing team.
  • Answers patient questions about the service, insurance issues, etc. in a timely and accurately manner.
  • Enters and maintains accurate prior authorization and patient assistance program records.
  • Completes all necessary paperwork, forms, records, and electronic documentation according to policy and procedures and regulations.
  • Evaluates and escalates “at risk” accounts to Pharmacy Leadership for review for financial exposure or write off.
  • Documents and submits requests for Patient Refunds when appropriate.
  • Manages time effectively by proactively prioritizing daily tasks, issue resolution, and work requests.

Qualifications

• High School Diploma or GED.
• Graduate of an approved technical, professional or vocational program or Bachelor's Degree, Associates Degree Equivalent experience accepted in lieu of degree.
• 2 - 3 years' Experience in Retail Pharmacy or Specialty Pharmacy, or work experience in insurance verification, benefits, financial assistance, and eligibility investigations.
• Will accept Certified Pharmacy Technicians, Medical Assistants, and LPNs.
• 3 - 4 years Certified Pharmacy Technician with previous Specialty Pharmacy Experience.
• Proficiency with operating systems (Word, Excel, Outlook) and basic computer skills.
• Discretion and confidentiality are essential, as position deals with highly sensitive and private data.

Skills

• Attention to detail.
• Interpersonal and communication skills.
• Medical and pharmaceutical terminology.
• Customer service.
• Problem-solving.
• Insurance and benefits management.

Benefits

We offer competitive shift differentials, opportunities for professional growth, and a comprehensive benefits package that may include medical, dental, vision, paid time off, retirement savings plans, and tuition reimbursement. For more information, please visit our benefits page: here.

Pay

Competitive hourly rate based on experience and education.

Schedule

Full time, 80 hours biweekly Day Shift Monday - Friday