Pharmacy Benefits & Access Specialist

ThedaCare; United States; On-site; USD 52,000 - 70,000; Full time

Benefits offered by this job

Lifestyle Engagement

Access & Affordability

Job summary

ThedaCare is seeking a Medication Access Specialist to join the Pharmacy Department. This role ensures the financial viability of patients as they flow through care, coordinating with patients, physicians, pharmacies, and insurers to obtain coverage and necessary authorizations.

Responsibilities include handling prior authorizations, medical record reviews, and facilitating medication refills, while maintaining excellent customer service and collaboration with internal and external teams.

Qualifications

• 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.
• Certification through Pharmacy Technician Certification Board or National Healthcare Association (ExCPT) required within the first 6 months of hire.

Responsibilities

• Review electronic medical records to collect information for prior authorizations and medication refills.
• Assist in obtaining updated prescription authorization for existing patients.
• Assist physician offices with documentation for prior authorization and refills.
• Update patients and offices on responses and outcomes of prior authorizations and refills.

Skills

Attention to detail

Interpersonal skills

Organizational skills

Teamwork

Independent work

Education

High school diploma or equivalent

4-year degree preferred

ASHP-accredited pharmacy tech training program preferred

Tools

EPIC

McKesson Enterprise

Insurance portals

Job description

ThedaCare is seeking a Medication Access Specialist to join the Pharmacy Department. This role ensures the financial viability of patients as they flow through care, coordinating with patients, physicians, pharmacies, and insurers to obtain coverage and necessary authorizations.

Responsibilities include handling prior authorizations, medical record reviews, and facilitating medication refills, while maintaining excellent customer service and collaboration with internal and external teams.