Medication Access Specialist

CLS Health; Webster (TX); On-site; USD 60,000 - 90,000; 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 PLLC in Houston, TX is seeking a skilled Medication Access Specialist to own the end-to-end process for specialty and infused medications. You will navigate payers, biosimilars, and manufacturer programs to move orders from submission to first treatment.

You will review orders, perform benefits investigations, determine patient financial responsibility, and coordinate routing with infusion centers and specialty pharmacies, ensuring seamless patient care.

Qualifications

• 3+ years in medication access or specialty pharmacy intake.
• Experience with J-codes and payer policies.
• Familiarity with copay assistance portals and PAP applications.
• Pharmacy technician certification preferred.

Responsibilities

• Receive and review medication orders from referring providers.
• Complete benefits investigation and determine coverage and patient financial responsibility.
• Determine routing for each order based on payer requirements.
• Submit and follow prior authorizations through payer workflows including appeals.
• Enroll patients in copay programs and PAP for free drug.
• Coordinate medication sourcing with pharmacy and distributor and confirm product selection per payer formulary.
• Schedule initial treatments and hand off to clinical staff.
• Track authorization expirations and reauthorizations.

Skills

Medication access

Prior authorization

Specialty pharmacy intake

Payer coordination

Copay assistance portals

Biosimilars knowledge

Education

Pharmacy technician certification

Tools

Copay portals

Manufacturer hub programs

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