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Medication Access Coordinator
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Medication Access Coordinator
Under general supervision, the Medication Access Coordinator will be responsible for completing necessary functions to ensure optimal reimbursement for high-cost medications for patients receiving care within a cardiovascular clinic. This role is also responsible for various other functions as described below.
Essential Functions of the Role:
• Collect and analyze supporting clinical documentation as appropriate for the prescription requested. Identify and initiate the processing of any missing clinical data such as labs, testing, medical records, etc.
• Submit prior authorization documents to the insurance company via preferred methods such as phone, fax or third-party websites. Call the insurance company directly to verify eligibility as needed.
• Communicate directly with insurance companies, providers, pharmacies and patients regarding prior authorizations status. Document all communications in EMR.
• Constant daily monitoring, organizing and review of multiple desktops within the EMR as well as other required computer applications. Ex. Cover my meds, Faxcom.
• Assist in completing prescription refills as needed.
• Provide explanation to patient’s regarding insurance deductibles, copays, coverage gaps as it applies to their prescription coverage.
• Provide and assist patients with resources to apply for patient assistance programs where eligible. Ex. Medicare, State programs, pharmaceutical companies, Non-profit organizations.
• Access or request medical records as required for authorization submission. Maintain access to computer applications needed for records. Ex. EPIC, LabCorp, Quest.
• Review insurance drug formularies to assist providers in selecting treatment in line to formulary selections.
• Submit appeals as appropriate with detailed, clinical response. Appeals processing may require sourcing such as peer reviewed articles or other clinically researched documentation.
• Other duties as assigned.
Minimum Qualifications:
• High school diploma or GED required.
• Understanding of medical terminology is required.
• Minimum 1 year experience in prior authorization, medical assistant, pharmacy technician, LPN or similar role is required. Cardiology experience highly preferred.
• Must have excellent customer service and oral / written communication skills.
• Must be detail oriented and use critical thinking skills.
• Must be a self-motivated individual, able to work independently with minimal guidance and as part of a team.
Work Environment
Must have the availability to work the required schedule, Monday-Friday 8:00 a.m. - 4:30 p.m.
Physical Requirements
This position requires full range of body motion. While performing the duties of this job, the employee is regularly required to sit, walk, and stand; talk or hear, both in person and by telephone; use hands repetitively to handle or operate standard office equipment; reach with hands and arms; and lift up to 25 pounds.
Equal Employment Opportunity Statement
We provide equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.
Salary and Benefits
Full-time, Non-exempt position. Competitive compensation and benefits package to include 401K; a full suite of medical, dental, and ancillary benefits; paid time off, and much more.
The statements contained herein are intended to describe the general nature and level of work performed by the Medication Access Coordinator, but is not a complete list of the responsibilities, duties, or skills required. Other duties may be assigned as business needs dictate. Reasonable accommodation may be made to enable qualified individuals with disabilities to perform the essential functions.
