Medication Access Specialist

Description About CLS Health CLS Health is a growing healthcare system in Houston, Texas that is taking a different approach to healthcare. We are a physician-led healthcare group that focuses on providing patients with holistic, multispecialty care. We're a dynamic team on a mission to provide better healthcare options for Houstonians! Position Summary Owns the end-to-end access process for specialty and infused medications across the infusion center and pharmacy. The right candidate knows the drugs, the payers, and the manufacturer programs, and can get a medication from order to first treatment with no gaps. Responsibilities Receive and review medication orders from referring providersComplete benefits investigation (medical vs pharmacy benefit) and determine coverage and patient financial responsibilityDetermine routing for each order: buy and bill through the infusion center or specialty pharmacy, based on payer requirementsSubmit and follow prior authorizations through payer and portal workflows, including appeals and peer-to-peer coordinationEnroll patients in copay card programs, manufacturer portals, foundation assistance, and patient assistance programs (PAP) for free drugCoordinate medication sourcing with the pharmacy and distributor and confirm product and biosimilar selection per payer formularySchedule initial treatments and hand off to clinical staffTrack authorization expirations and reauthorizations Benefits 401(k) matchingDental InsuranceDisability insuranceHealth insuranceLife insurancePaid time off Requirements 3+ years in medication access, prior authorization, or specialty pharmacy intake, preferably in an infusion or specialty clinic settingWorking knowledge of J-codes, biosimilars, buy and bill, specialty pharmacy, and medical vs pharmacy benefitHands-on experience with copay assistance portals, manufacturer hub programs, and PAP applicationsFamiliarity with major commercial, Medicare Advantage, and Medicaid payer policies for specialty drugsStrong organization and follow-through; comfortable managing a high volume of open casesPharmacy technician certification or similar is a plus