Medication Access Coordinator

geisinger; United States; Remote; USD 55,000 - 75,000; Full time

Job summary

Geisinger is seeking a Prior Authorization Specialist to work from home in Pennsylvania. You will obtain prior authorizations for medications, determine coverage with payers, and liaise with insurance companies, departments, and patients.

You will serve as a subject matter expert on patient medication assistance foundations and reimbursement programs, ensuring timely access to therapies. Responsibilities include researching payer criteria, documenting referrals, and educating care teams on

Qualifications

• Experience obtaining prior authorizations for medications.
• Ability to research payer criteria and determine coverage for prescribed treatments.
• Familiar with patient assistance programs and medication reimbursement methodologies.

Responsibilities

• 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 and tracks changes in payer criteria.
• Communicates with the care team to provide details on authorization status.
• Maintains knowledge of patient assistance programs and eligibility requirements.
• Identifies and discusses with patients the affordability of prescribed treatments and available programs.
• Ensures accurate completion of enrollment paperwork for assistance programs.
• Tracks fund award end dates and re-apply as necessary to avoid therapy lapse.
• Educates providers and patients on specialty services and how this improves patient care.

Skills

Computer literacy

Customer service

Healthcare industry

Medical records management

Education

High School Diploma or GED

Job description

Location:

Work from home (Pennsylvania)

Shift: Days (United States of America)

Scheduled Weekly Hours: 40

Worker Type: Regular

Exemption Status: No

Job Summary:

"PA Residents Only"

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. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. 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).

Position Details:

Education:

High School Diploma or Equivalent (GED)- (Required)

Experience:

Minimum of 2 years-Related work experience (Required)

Skills:

• Computer Literacy
• Customer Service
• Healthcare Industry
• Medical Records Management

OUR PURPOSE & VALUES:

KINDNESS: We strive to treat everyone as we would hope to be treated ourselves.

EXCELLENCE: We treasure colleagues who humbly strive for excellence.

LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow.

INNOVATION : We constantly seek new and better ways to care for our patients, our members, our community, and the nation.

SAFETY: We provide a safe environment for our patients and members and the Geisinger family.

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

Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, status as a protected veteran, or any other protected category under applicable federal, state, and local laws.