MEDICATION ACCESS SPECIALIST I, FHP - PHARMACY-MPA

Froedtert ThedaCare; Menomonee Falls (WI); Hybrid; USD 52,000 - 65,000; Full time

Benefits offered by this job

Paid time off

Growth opportunities

Educational partnerships with Medical,

Referral bonuses

Retirement plan - 403b

Medical, Dental, Vision, Life; STD/LTD

Employee Assistance Programs

Job summary

Froedtert ThedaCare is seeking a Medication Access Specialist in Menomonee Falls, WI. Hybrid role with 40-hour weeks to support the Pharmacy Department by securing insurance coverage, managing prior authorizations, and coordinating with patients, providers, and payers.

Qualified candidates will have at least 3 years in pharmacy/healthcare insurance, a High School diploma or equivalent, and Wisconsin tech registration by hire date; a 4-year degree and ExCPT/CPhT certification are preferred.

Qualifications

• Minimum of 3 years of experience in pharmacy, healthcare, managed care, or health insurance environment.
• Knowledge of health insurance terminology, billing, and prior authorization processes.
• High School diploma or equivalent is required; 4 year degree preferred.
• Wisconsin Pharmacy Technician registration required by hire date; certification (CPhT/ExCPT) within 6 months.

Responsibilities

• Act as liaison between patient, physician, pharmacy, insurance providers, and third parties to initiate and resolve appeals.
• Obtain medication insurance coverage or assistance and authorization information; monitor insurance status.
• Submit information for prior authorizations and medication refills, including diagnoses and history.
• Update patient, physician, and other parties via phone, in-basket messages, and EMR about outcomes.
• Read and interpret insurance documents and communicate effectively across channels.
• Problem solve timely and manage multiple tasks in a team environment.

Skills

Attention to detail

Third party insurance

Interpersonal skills

Organizational skills

EHR navigation

Multi-tasking

Teamwork

Education

High School diploma or equivalent

4 year degree

Tools

EPIC

McKesson Enterprise

Insurance portals

Job description

#BeHere

Location: US:WI:MENOMONEE FALLS at our INTEGRATED SERVICE CENTER facility.

This job is HYBRID.

FTE: 1.000000

Standard Hours:40.00

Shift: Shift 1

Shift Details: Holidays: Weekends:

Job 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. 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.) Problem solve as needed within a timely manner Effective time management of tasks and responsibilities. The ability to discern when it is appropriate to hand off a tasks Detail oriented with ability to effectively and efficiently multi-task Ability to work in a team environment Other duties as assigned

Other information:

EXPERIENCE REQUIRED: A minimum of 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.

EXPERIENCE PREFERRED: None

EDUCATION REQUIRED: High School diploma or equivalent is required.

EDUCATION PREFERRED: 4 year degree preferred. Graduate of ASHP accredited pharmacy tech training program preferred.

TRAINING REQUIRED: None

TRAINING PREFERRED: None

SPECIAL SKILLS REQUIRED: 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.

SPECIAL SKILLS PREFERRED: None

LICENSURE REQUIRED: Application for Wisconsin registration as a Pharmacy Technician is required by hire date and must be obtained within 12 months of hire. Staff hired into this role prior to 3/31/23 must have applied for Wisconsin registration by 3/31/23 and have until 3/31/24 to obtain registration. Certification through Pharmacy Technician Certification Board or National Healthcare Association (ExCPT) required within the first 6 months of hire.

LICENSURE PREFERRED: None

Perks & Benefits At Froedtert Health

• Paid time off
• Growth opportunity- Career Pathways & Career Tuition Assistance, CEU opportunities
• Academic Partnership with the Medical College of Wisconsin
• Referral bonuses
• Retirement plan - 403b
• Medical, Dental, Vision, Life Insurance, Short & Long Term Disability, Free Workplace Clinics
• Employee Assistance Programs, Adoption Assistance, Healthy Contributions, Care@Work, Moving Assistance, Discounts on gym memberships, travel and other work life benefits available

The Froedtert & the Medical College of Wisconsin regional health network is a partnership between Froedtert Health and the Medical College of Wisconsin supporting a shared mission of patient care, innovation, medical research and education. Our health network operates eastern Wisconsin's only academic medical center and adult Level I Trauma center engaged in thousands of clinical trials and studies. The Froedtert & MCW health network, which includes ten hospitals, nearly 2,000 physicians and more than 45 health centers and clinics draw patients from throughout the Midwest and the nation.

We are proud to be an Equal Opportunity Employer who values and maintains an environment that attracts, recruits, engages and retains a diverse workforce. We welcome protected veterans to share their priority consideration status with us at 262-439-1961. We maintain a drug-free workplace and perform pre-employment substance abuse testing. During your application and interview process, if you have a need that requires an accommodation, please contact us at 262-439-1961. We will attempt to fulfill all reasonable accommodation requests.