Medication Access Specialist

CLS; Webster (TX); On-site; USD 65,000 - 85,000; Full time

Benefits offered by this job

401(k) matching

Dental Insurance

Disability insurance

Health insurance

Life insurance

Paid time off

Job summary

CLS Health in Houston, TX is seeking a specialist to own end-to-end access for specialty and infused medications across the infusion center and pharmacy. The role focuses on navigating payers, manufacturer programs, and ensuring seamless progression from order to first treatment.

You will review orders, perform benefits investigations, route orders by payer requirements, and manage prior authorizations, copay assistance, and PAP applications to minimize patient barriers to therapy.

Qualifications

• 3+ years in medication access, prior authorization, or specialty pharmacy intake, preferably in an infusion or specialty clinic setting.
• Working knowledge of J-codes, biosimilars, buy and bill, specialty pharmacy, and medical vs pharmacy benefit.
• Hands-on experience with copay assistance portals, manufacturer hub programs, and PAP applications.
• Familiarity with major commercial, Medicare Advantage, and Medicaid payer policies for specialty drugs.
• Strong organization and follow-through; comfortable managing a high volume of open cases.
• Pharmacy technician certification or similar is a plus.

Responsibilities

• Receive and review medication orders from referring providers.
• Complete benefits investigation (medical vs pharmacy benefit) and determine coverage and patient financial responsibility.
• Determine routing for each order: buy and bill through the infusion center or specialty pharmacy, based on payer requirements.
• Submit and follow prior authorizations through payer and portal workflows, including appeals and peer-to-peer coordination.
• Enroll patients in copay card programs, manufacturer portals, foundation assistance, and patient assistance programs (PAP) for free drug.
• Coordinate medication sourcing with the pharmacy and distributor and confirm product and biosimilar selection per payer formulary.
• Schedule initial treatments and hand off to clinical staff.
• Track authorization expirations and reauthorizations.

Skills

Prior authorization

Pharmacy intake

Copay coordination

Organizational skills

Education

Pharmacy technician certification

Tools

Copay assistance portals

Manufacturer hub programs

PAP applications

Job description

Description

About CLS Health

CLS Health is a growing healthcare system in Houston, Texas that is taking a different approach to healthcare. We are a physician-led healthcare group that focuses on providing patients with holistic, multispecialty care. We're a dynamic team on a mission to provide better healthcare options for Houstonians!

Position Summary

Owns the end-to-end access process for specialty and infused medications across the infusion center and pharmacy. The right candidate knows the drugs, the payers, and the manufacturer programs, and can get a medication from order to first treatment with no gaps.

Responsibilities:

• Receive and review medication orders from referring providers
• Complete benefits investigation (medical vs pharmacy benefit) and determine coverage and patient financial responsibility
• Determine routing for each order: buy and bill through the infusion center or specialty pharmacy, based on payer requirements
• Submit and follow prior authorizations through payer and portal workflows, including appeals and peer-to-peer coordination
• Enroll patients in copay card programs, manufacturer portals, foundation assistance, and patient assistance programs (PAP) for free drug
• Coordinate medication sourcing with the pharmacy and distributor and confirm product and biosimilar selection per payer formulary
• Schedule initial treatments and hand off to clinical staff
• Track authorization expirations and reauthorizations

Benefits:

• 401(k) matching
• Dental Insurance
• Disability insurance
• Health insurance
• Life insurance
• Paid time off

Requirements

• 3+ years in medication access, prior authorization, or specialty pharmacy intake, preferably in an infusion or specialty clinic setting
• Working knowledge of J-codes, biosimilars, buy and bill, specialty pharmacy, and medical vs pharmacy benefit
• Hands-on experience with copay assistance portals, manufacturer hub programs, and PAP applications
• Familiarity with major commercial, Medicare Advantage, and Medicaid payer policies for specialty drugs
• Strong organization and follow-through; comfortable managing a high volume of open cases
• Pharmacy technician certification or similar is a plus