When you join the growing BILH team, you're not just taking a job, you're making a difference in people's lives.
Job Summary: The Medication Access Specialist will fulfill all of the job responsibilities as needed and coordinate for at least one or more specialty clinics. This position acts as a care coordination specialist between specialty/retail pharmacy and the prescribers. Responsible for documenting, submitting, communicating outcomes and appeal all pharmacy and medical buy and bill prior authorizations. Involved in all aspects of obtaining patient access to prescribed medications such as benefit investigation, white bagging, financial assistance (grants/foundations/copay cards) and manage the Employee Variable Co-Pay Program.
Job Description:
Essential Responsibilities:
Serves as a subject matter expert for physicians, administrators, clinical staff, pharmacy staff, and third party payers for issues regarding prior authorization approvals, ambulatory infusion reimbursement and Patient Assistance programs.
Collects and reviews all data needed for pharmacy and medical prior authorization approvals. Provides formulary assistance for clinic administered or infusion medications through evaluating necessity of prior authorization and identification of formulary alternatives.
Obtains initial and renewal insurance authorization for infusion medications as required by insurance plans and provide infusion cost estimates to patients or clinic staff.
Facilitates patient enrollment in available programs, handles customized communications, ensures ongoing claims processing accuracy and efficient delivery throughout the treatment period with a high-touch, member centric process and manages plan reporting.
Manages enrollment and services under the Employee Variable Co-Pay Program by reducing employee and plan sponsor costs and minimizing compliance risks. Assists patients with various forms of financial assistance by serving as a patient advocate to communicate and coordinate with drug manufacturers, PBMs and dispensing pharmacies.
Provides exceptional customer service to internal and external customers; resolves any patient requests in a timely and accurate manner; escalates complaints accordingly; maintains frequent phone contact with patient, provider and pharmacy staff; and clarifies prescription orders with pharmacist and/or clinician as appropriate.
Serves as the direct patient and provider contact for pharmacy benefits information, clinical and program information. Coordinates services with providers, specialty pharmacies and national account managers to improve turnaround time for patients.
Manages multiple strategic initiatives simultaneously and reprioritize where necessary, independently and effectively resolves complex accounts, and determines methods and procedures on new or special assignments with minimal supervision.
Networks with key payor and manufacture contacts inside and outside own area of expertise.
Provides training and support to inter-departmental associates. Cross cover other primary care and specialty clinics as needed.
Required Qualifications:
High School diploma or GED required.
License Mass Registered Pharmacy Tech required., and Certificate 1 Certfied Pharmacy Technician required.
3-5 years related work experience required in specialty pharmacy and medical prior authorization experience or a minimum of 4 years of pharmacy work experience.
Working knowledge of Common Procedural Terminology (CPT), Health Care Procedural Coding System (HCPCS) J Codes and International Classification of Diseases (ICD-10).
Experience with medical buy & bill and specialty clinic authorization management.
Must obtain PACS certification within twelve months of hire.
Experience with computer systems required, including web based applications and some Microsoft Office applications which may include Outlook, Word, Excel, PowerPoint or Access.
Preferred Qualifications:
Prior lead or supervisor experience. Familiarity with 340B drug program.
Deep knowledge of medication use in MS, RA, GI, transplant, hepatitis C, infectious disease (including HIV), and/or oncology a plus.
Advanced Certificate Pharmacy Technician credential (CPhT-Adv).
Competencies:
Decision Making: Ability to make decisions that are guided by precedents, policies and objectives. Regularly makes decisions and recommendations on issues affecting a department or functional area.
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. Work progress is monitored by supervisor/manager.
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.
Physical Nature of the Job:
Sedentary work: Exerting up to 10 pounds of force occasionally in carrying, lifting, pushing, pulling objects. Sitting most of the time, with walking and standing required only occasionally
Pay Range:
$32.00 - $43.07
The pay range listed for this position is the base hourly wage range the organization reasonably and in good faith expects to pay for this position at this time. Actual compensation is determined based on several factors, that may include seniority, education, training, relevant experience, relevant certifications, geography of work location, job responsibilities, or other applicable factors permissible by law. Compensation may exceed the base hourly rate depending on shift differentials, call pay, premium pay, overtime pay, and other additional pay practices, as applicable to the position and in accordance with the law.
As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) as a condition of employment.
More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger.
Equal Opportunity Employer/Veterans/Disabled
