Specialty Medication Access Coordinator

Job Description

Serves as the on-site subject matter expert for providers, clinic staff, and pharmacy teams on prior authorizations, reimbursement, and patient assistance for complex and specialty therapies.

Independently manages pharmacy and medical benefit authorizations, identifying formulary alternatives and ensuring timely approvals that support continuity of care.

Oversees insurance authorization and financial clearance for specialty and infusion medications, providing cost estimates and preventing treatment delays.

Covers patient enrollment and ongoing support in manufacturer or financial assistance programs to ensure affordability and uninterrupted therapy access.

Administers the Employee Variable Co-Pay Program and advocates for patients through direct collaboration with manufacturers, PBMs, and specialty pharmacies.

Delivers high-level customer service and communication, maintaining proactive contact with patients, providers, and pharmacies to resolve access barriers efficiently.

Acts as the primary point of contact for benefits, clinical coordination, and program eligibility inquiries, streamlining processes across stakeholders.

Drives operational efficiency and quality improvement, independently resolving complex cases and advancing best practices within the clinic.

Develops and maintains strategic relationships with payers, manufacturers, and specialty partners to anticipate and navigate policy or coverage changes.

Provides mentorship and training to Medication Authorization and Access team members and supports cross-coverage across specialty and primary care clinics.

Required Qualifications

• High School diploma or GED required.
• Pharmacy Technician License (Massachusetts) - Massachusetts Board of Pharmacy.
• PTCB National Certification must be obtained within six months of hire.
• 5 years related work experience required in specialty pharmacy and pharmacy prior authorization experience.
• Proven track record of successfully managing stakeholder relationships and driving service adoption.

Preferred Qualifications

• Leadership or training experience within a pharmacy, clinic, or medication access program.
• Familiarity with 340B and integrated health system pharmacy models.
• Comprehensive clinical knowledge of therapies used in specialty disease states (e.g., MS, RA, GI, transplant, oncology, hepatitis C, or infectious diseases including HIV).
• Advanced Certificate Pharmacy Technician credential (CPhT-Adv).
• Experience implementing process improvement or access optimization initiatives within a health system or specialty pharmacy setting.

Competencies

• Decision Making: Ability to make decisions that are guided by precedents, policies and objectives.
• Problem Solving: Ability to address problems that are varied, requiring analysis or interpretation of the situation using direct observation, knowledge and skills based on general precedents.
• Independence of Action: Ability to follow precedents and procedures. May set priorities and organize work within general guidelines. Seeks assistance when confronted with difficult and/or unpredictable situations.
• Written Communications: Ability to communicate clearly and effectively in written English with internal and external customers.
• Oral Communications: Ability to comprehend and communicate complex verbal information in English to medical center staff, patients, families and external customers.
• Knowledge: Ability to demonstrate in-depth knowledge of concepts, practices and policies with the ability to use them in complex varied situations.
• Team Work: Ability to act as a team leader for small projects or work groups, creating a collaborative and respectful team environment and improving workflows.
• Results may impact the operations of one or more departments.
• Customer Service: Ability to provide a high level of customer service to patients, visitors, staff and external customers in a professional, service-oriented, respectful manner using skills in active listening and problem solving. Ability to remain calm in stressful situations.

Pay Range

$33.60 - $45.22