Medication Access Specialist

ThedaCare; Appleton (WI); On-site; USD 42,000 - 65,000; Full time

Benefits offered by this job

Health coaches

Relaxation rooms

Mental health support

Low copays

Job summary

ThedaCare, located in Appleton, Wisconsin, seeks a Medication Access Specialist in the Pharmacy Department to manage medication coverage, authorizations, and appeals for patients. You will liaise with patients, physicians, and insurers to secure timely access to therapies.

Ideal candidates have 3 years in pharmacy or health insurance, strong insurance knowledge, and excellent communication in a fast-paced setting.

Qualifications

• 3 years of experience in pharmacy, healthcare, or health insurance required.
• Knowledge of health insurance terms, billing, and hospital reimbursement.
• ASHP-accredited pharmacy technician training preferred.

Responsibilities

• Submit, appeal, and resolve prior authorizations and med refills.
• Obtain updated prescription authorizations for existing patients.
• Coordinate with physicians, insurers, and patients to resolve coverage issues.
• Communicate outcomes via phone, messaging, or EMR.
• Maintain timely follow-up on prior authorizations and refills.
• Provide high-level customer service and support across teams.

Skills

Attention to detail

Interpersonal skills

EPIC

McKesson Enterprise

Insurance portals

Electronic Health Record

Education

High school diploma or equivalent

4-year degree preferred

ASHP accredited pharmacy tech training program preferred

Tools

EPIC

McKesson Enterprise

Insurance portals

Electronic Health Record

Job description

Why ThedaCare?

Living A Life Inspired! Our new vision at ThedaCare is bold, ambitious, and ignited by a shared passion to provide outstanding care. We are inspired to reinvent health care by becoming a proactive partner in health, enriching the lives of all and creating value in everything we do. Each of us are called to take action in delivering higher standards of care, lower costs and a healthier future for our patients, our families, our communities and our world. At ThedaCare, our team members are empowered to be the catalyst of change through our values of compassion, excellence, leadership, innovation, and agility. A career means much more than excellent compensation and benefits. Our team members are supported by continued opportunities for learning and development, accessible and transparent leadership, and a commitment to work/life balance. If you’re interested in joining a health care system that is changing the face of care and well-being in our community, we encourage you to explore a future with ThedaCare.

Benefits

Benefits, with a whole-person approach to wellness – Lifestyle Engagement e.g. health coaches, relaxation rooms, health focused apps (Wonder, Ripple), mental health support Access & Affordability e.g. minimal or zero copays, team member cost sharing premiums, daycare

About ThedaCare!

Summary : The Medication Access Specialist is a dedicated member of the Pharmacy Department team who is responsible for assuring the financial viability of patients as they flow through the continuum of care. Acts as the liaison between patient, physician office, pharmacy, insurance providers, and other third parties to initiate and resolve appeals, as needed Acts as a liaison between patients, foundations, manufactures or necessary parties, to obtain financial prescription assistance for patients in need. Responsible for obtaining medication insurance coverage or assistance and benefit information, authorizations of medications, monitors patient's insurance status, assists in facilitating medication refill requests, and communicates insurance issues to the treatment team.

Job Description

JOB RESPONSIBILITIES

• Reviews electronic medical record for patients to collect any pertinent information needed to submit, appeal, and resolve prior authorizations and medication refills requests (such as diagnoses, past medical history, past prescription history, and other information)
• Assists in obtaining updated prescription authorization for existing patients
• Assists the physician's office in obtaining and completing any and all documentation necessary to complete prior authorization and medication refill requests
• Updates the patient, physician's office, any necessary parties through multiple methods as appropriate (include telephone, in-basket messaging, and electronic medical record), regarding responses and outcomes of prior authorizations and medication refills
• Requires appropriate follow up with physician's office and any necessary parties in regards to status of prior authorizations and medication refill requests
• Read, interpret, and effectively communicate information from insurance documents, electronic medical records, patient charts
• Effectively participate in both written and verbal communication through multiple means (such as electronic health record, in basket messages, phone calls, emails, etc.)
• Collaborates with both internal and external customers in responding to and resolving pharmacy-related inquiries from patients, providers, or pharmacists
• Participates in the coverage determination (certification, prior authorization, Exception to coverage, etc.) process by reviewing all requests which are approvable based on clinical criteria.
• Provides a high level of customer service to all internal and external customers.
• Leads service recovery efforts in respective area if needed.
• Actively works to resolve customer concerns and manages difficult situations to promote a high level of customer satisfaction.
• Works within the department and individual groups to maintain a focus on common goals and service to the end customer (the patient).
• Problem solves as needed within a timely manner
• Effective time management of tasks and responsibilities. The ability to discern when it is appropriate to hand off tasks
• Detail oriented with ability to effectively and efficiently multi-task.
• Ability to work in a team environment.
• Other duties as assigned.

QUALIFICATIONS

• EXPERIENCE: 3 years of experience in pharmacy, healthcare, managed care, or other health insurance environment is required.
• Knowledge of health insurance and pharmacy insurance benefit verification, health insurance terminology, billing, managed care contracting, hospital reimbursement, and hospital admitting and registrations practices required.
• EDUCATION: High school diploma or equivalent is required. 4-year degree preferred. Graduate of ASHP accredited pharmacy tech training program preferred.
• Special skills: Proven attention to detail. Experience with third party insurance and medication/co-pay assistance programs. Effective interpersonal skills, including the ability to develop collaborative alliances, promote teamwork and ensure a high degree of internal and external customer satisfaction. Outstanding organizational and follow-up skills. Experience with various computer systems and programs (such as EPIC, insurance portals, McKesson Enterprise, etc.). Quick learner Ability to work independently and take programmatic initiative. Ability to function in a fast paced and changing environment and balance multiple priorities. Experience with navigating an Electronic Health Record.
• LICENSURE: Certification through Pharmacy Technician Certification Board or National Healthcare Association (ExCPT) Required within the first 6 months of hire.
• QUALITIES: Ability to support, advance and live our mission and evidence of such: Mission – Our reason for Being - To advance the health of our communities through excellence and discovery, inspiring each person to live their unique best life Ability to support, advance and work toward our vision and evidence of such. Vision - Who we Aspire to be - To be your trusted partner, transforming health care for everyone every day Commitment to and evidence of demonstrating our guiding principles.

Scheduled Weekly Hours: 40 Scheduled FTE: 1 Location: Corporate - 2300 E Capitol Dr - Appleton,Wisconsin Overtime Exempt: No Worker Shift Details: Days

ThedaCare is a community health system consisting of seven hospitals, numerous clinics and related services. We are the third largest health care employer in Wisconsin and the largest employer in the state's second largest economic market - Northeast Wisconsin - with approximately 6,800 employees. Through our 100-year history, ThedaCare has woven itself into the very fabric of the communities we serve. For our employees, ThedaCare offers an environment that not only welcomes but also encourages innovative thinking and fresh approaches to today’s health care challenges. We’ve improved the health of thousands of individuals. We know this because we track our quality and constantly seek to improve our care and services for the members of our communities.

Equal Opportunity Statement: ThedaCare is an Equal Opportunity Employer. ThedaCare complies with applicable Federal civil rights laws and does not discriminate on the basis of race, ancestry, color, religion, sex, gender identity, age, marital status, sexual orientation, national origin, medical condition, disability, veteran status, or any other basis protected by law.