Medication Access Coordinator I

Geisinger; United States; Remote; USD 65,000 - 90,000; Full time

Job summary

Geisinger in the United States seeks a pharmacist to manage prior authorizations and referrals for medications, using third-party payer criteria. You will research and follow up within set timeframes and communicate authorization details to the care team.

You will educate providers and patients about specialty services, assist programs, and help grow the specialty pharmacy patient population. This role may require floating to areas with workload fluctuations while following policies.

Qualifications

• Prior authorization experience with third-party payers.
• Knowledge of third-party payer criteria and eligibility requirements.
• Experience identifying and coordinating patient assistance programs.
• Ability to educate providers and patients on specialty services.

Responsibilities

• Completes prior authorization and documents referrals for medications reviewed using payer criteria.
• Conducts research and follow-up within established timeframes; tracks changes in payer criteria.
• Communicates authorization status and details with the care team.
• Maintains knowledge of patient assistance programs and eligibility requirements.
• Identifies and discusses affordable options with patients and arranges enrollment in assistance programs.
• Ensures accurate completion of necessary paperwork for enrollment in assistance programs.
• Tracks fund award end dates and re-applies to prevent lapses in therapies.
• Helps communicate status of assistance applications to the care team.
• Educates providers and patients on specialty services to improve patient care and grow the specialty pharmacy population.
• Floats to areas of variable workload to provide patient services as needed.
• Adheres to organization policies and job obligations.

Job description

• 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).