Medication Access Specialist, Specialty Pharmacy

Virginia Commonwealth University Health; Richmond (VA); On-site; USD 45,000 - 70,000; Full time

Job summary

Virginia Commonwealth University Health is seeking a Medication Access Specialist to ensure timely access to medication for patients. This role involves coordinating with insurance carriers, providing patient resources, and enhancing adherence to therapies. Candidates must have a high school diploma and relevant certification, with experience in pharmacy practices preferred. Join a dedicated team in a fast-paced environment focused on patient care and quality service.

Qualifications

• Minimum of one year previous pharmacy practice or Specialty pharmacy experience.
• Minimum of one year of customer service or call-center experience.
• Experience with prior authorizations and Patient Assistance Programs is preferred.

Responsibilities

• Ensure timely medication access and perform claims adjudications.
• Complete prior authorizations and track insurance responses.
• Provide patient support and facilitate adherence to medications.

Skills

Cultural Responsiveness

Customer Service

Communication

Problem Solving

Teamwork

Education

High School Diploma or equivalent

Current certification by the Pharmacy Technician Certification Board (PTCB)

Job description

Medication Access Specialist, Specialty Pharmacy page is loaded

Medication Access Specialist, Specialty Pharmacy

Apply locations Richmond, VA time type Full time posted on Posted Yesterday job requisition id R36694 The Medication Access Specialist (MAS) is responsible for completing necessary functions to ensure timely medication access for high cost, self-administered or in-clinic administered medications. This role will provide resources to patient to minimize out of pocket cost while maximizing pharmacy reimbursement.

Essential Job Statements

• Reviews prescription for accuracy of prescribed treatment regimen, complete data entry of prescription, adjudicate pharmacy claims, and resolve adjudication errors and rejections.

• Completes pharmacy benefits investigation and coordination, initiate and complete prior authorization approval and/or denials (appeals), track progress, and expedite responses from insurance carriers and payers. and coordinate additional assistance (as needed) with copay cards, grant funding, and patient assistance programs.

• Participates in Specialty pharmacy call center activities and triage. The MAS is responsible for incoming calls from patients, payers, and providers to ensure pharmacy call response requirements are met for accreditation(s).

• Facilitates adherence to medications by ensuring that patients receive prescribed medications in a timely manner. Document and triage patient problems with therapy to the appropriate pharmacist; assure documentation of problem and follow-up with patient and assist with coordination of filling.

• Enhances medication access by preventing therapy interruptions due to insurance issues in conjunction with pharmacists, physicians, and clinic staff. Communicate and collaborate regarding patient therapy interruptions, additional therapy monitoring requirements, and alternative care delivery setting options.

• Expedites resolution of delivery and dispensing problems that may occur to ensure continued medication access.

• Participates in the Specialty pharmacy quality management committee.

• Mentors/Trains Assists in the orientation and/or instruction of new employees in the role of MAS.

• Works as a Pharmacy Technician when deemed necessary.

Patient Population

Demonstrates the knowledge and skills necessary to provide equitable care appropriate to the age of the patients served on their assigned unit.

Demonstrates knowledge and related competencies of the principles of growth and development of the life span and possesses the ability to assess data reflective of the patient's status and interprets the appropriate information needed to identify each patient's requirements relative to their age, specific needs and to provide the equitable care needed as described in departmental policies and procedures.

Neonates (0-4 weeks)

Infant (1-12 months)

Pediatrics (1-12 years)

Adolescents (13-17 years)

Adults (18-64 years)

Geriatrics (65 years and older)

Employment Qualifications

Required Education:

High School Diploma or equivalent Education/training

Preferred Education:

Licensure/Certification Required:

Current certification by the Pharmacy Technician Certification Board (PTCB)

Current licensure with the Virginia State Board of Pharmacy By virtue of societal trust and security explicitly imparted to pharmacies for the control of drugs, candidate/incumbent must have a clean criminal record (i.e. no felony conviction; no drug or pharmacy related convictions, including misdemeanors); no denial, suspension, revocation, or restriction of registration or licensure by any State Board of Pharmacy Licensure, Certification, or Registration

Licensure/Certification Preferred:

Minimum Qualifications

Years and Type of Required Experience

Minimum of one (1) year previous pharmacy practice or Specialty pharmacy experience

Minimum of one (1) year of customer service or call-center experience

Other Knowledge, Skills and Abilities Required:

Cultural Responsiveness

Respond respectfully and effectively to people of all cultures, languages, classes, races, ethnic backgrounds, disabilities, religions, genders, sexual orientations, and other diversity factors in a manner that recognizes, affirms, and values their worth.

Other Knowledge, Skills and Abilities Preferred:

Minimum of one (1) year prior experience with prior authorizations, Patient Assistance Programs, and prior experience with prescription on-line adjudication.

Previous work experience using a personal computer andvarious billing software applications as well as e-mail, spreadsheets, word processing, databases, etc.

Working Conditions

Periods of high stress and fluctuating workloads may occur.

General office environment.
May be exposed to high noise levels and bright lights.

May be exposed to limited hazardous substances or body fluids. *

May be exposed to human blood and other potentially infectious MASerials. *

May have periods of constant interruptions.

* Individuals in this position are required to exercise universal precautions, use personal protective equipment and devices, and learn the policies concerning infection control.

Physical Requirements

Physical Demands: Lifting/ Carrying (0-50 lbs.), Push/ Pull (0-50 lbs.), Stoop, Kneel, Squat, Bending

Work Position: Sitting, Walking, Standing

Additional Physical Requirements/ Hazards

Physical Requirements: Manual dexterity (eye/hand coordination), Perform shift work, Hear alarms/telephone/tape recorder, Reach above shoulder, Repetitive arm/hand movements, Finger Dexterity, Color Vision, Acuity - far, Acuity - near

Hazards: Use of Latex Gloves, Exposure to moving mechanical parts, Exposure to high pitched noises

Mental/Sensory –Emotional

Mental / Sensory: Strong Recall, Reasoning, Problem Solving, Hearing, Speak Clearly, Write Legibly, Reading, Logical Thinking

Emotional: Fast-paced environment, Able to Handle Multiple Priorities, Frequent and Intense Customer Interactions, Noisy Environment, Able to Adapt to Frequent Change

EEO Employer/Disabled/Protected Veteran/41 CFR 60-1.4.

About Us

Who We Are

Inventing better care, day by day by discovery

Sound outrageous? It absolutely is. Sound impossible? That’s never stopped us before. Sound like hard work, intense research, collaboration with experts around the world, sheer brainpower meets unrelenting willpower? That’s. Exactly. Right.

We’ll do whatever it takes to offer the best in care and empower the best in quality of life. And it’s an approach that works — whether it’s a patient who undergoes a new, life-saving procedure or a clinical researcher who finds promise in a new cancer treatment, exciting new medicine is happening at VCU Health.

We have it all:
• One college and four health sciences schools
• An academic medical center
• A Level I trauma center
• One of only two NCI-designated cancer centers in Virginia
• The region’s only full-service children’s hospital
• More than 800 physicians in 200 specialties
• With a community health center, dedicated research teams, facilities and valued partners in every field

Our medical teams are top notch. And we’re not too shy to boast of internationally known physicians, some recognized as the best in the country, top-ranked local specialists and all-around all-stars at every level. From our very first years to our most recent advancements, we are driven to learn more, dig deeper, teach passionately and never rest in order to be a true leader in discovering what’s possible in health and recovery. We are a comprehensive system of care and a pioneer of health. Read VCU Health Year In Review for more about our accomplishments.