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Medication Access Specialist
2 months ago
**Location**:
Miramar, Florida
At Memorial Healthcare System (MHS), our ever-growing pharmacy career options present unlimited opportunities to individuals passionate about advancing pharmacy practice. As a nationally recognized and respected leader for providing “A-rated” patient care and safety, MHS prides itself on being able to grow and adapt to the rapidly evolving needs of our community and healthcare industry.
**Summary**:
Responsible for performing benefit coverage investigations, initiating, processing, resolving prior authorizations (including denials), helping patients obtain financial assistance from pharmacy related services. Coordinates enrollment, utilization, and ongoing eligibility for manufacturer patient assistance programs to ensure access to medications and compliance with program requirements. Responsible preparing monthly pharmaceutical savings reports and responding to patient assistance program audits.
**Responsibilities**:
Tracks, trends and reports financial data related to drug reimbursement and replacement transactions.Improves access to pharmaceutical therapy by performing pharmacy benefit investigation, prior authorizations, copay assistance, enrollment in manufacturer free drug programs, including medication replacement and appeals as appropriate.Processes patient financial documentation for pharmacy financial assistance eligibility. Develops reimbursement payments schedules for patients with special needs. Tracks status of expiring reimbursements and processes renewals for patients as appropriate.Performs pharmacy benefit investigation and applies knowledge and understanding of the coverage rules by third party payers, including Medicare and Medicaid. Identifies therapies that require certification of medical necessity. Works with providers and payers to obtain approval. Initiates support for appeals to denied authorizations for pharmacy services.Participates in pharmacy reimbursement initiatives that increase patient access to pharmaceutical services and promotes cost savings to the health system.Assesses, assists and enrolls patients that require financial assistance for pharmacy services. Contacts pharmaceutical companies to obtain information and enrolls patients into pharmaceutical patient assistance programs. Monitors and coordinates re-enrollment or transition into additional pharmacy service lines.Ensures compliance with financial and regulatory requirements. Coordinates and ensures appropriates credit to patient accounts when applicable.Coordinates receipt, delivery and distribution of free drug, drug replacements and bulk pharmaceuticals.
**Competencies**:
ACCOUNTABILITY, ANALYSIS AND DECISION MAKING - PHAP, CUSTOMER SERVICE, FINANCIAL COUNSELING - PATIENT SERVICES, PATIENT AND FAMILY CENTERED CARE, PROBLEM SOLVING, RESPONDING TO CHANGE, STANDARDS OF BEHAVIOR, VERIFY INSURANCE
**Education and Certification Requirements**:
High School Diploma or Equivalent (required)Certified Pharmacy Technician (CPHT) - Pharmacy Technician Certification Board (PTCB), Registered Pharmacy Technician (RPT LICENSE) - State of Florida (FL)
**Additional Job Information**:
Complexity of Work: Requires critical thinking skills, effective communication skills, decisive judgment and the ability to work with mínimal supervision. Must be able to work in a stressful environment and take appropriate action.Required Work Experience: Three (3) years of pharmacy experience. Proficient understanding of the delivery of healthcare across multiple service lines.Other Information: Certified pharmacy technician through a nationally accredited organization.
**Working Conditions and Physical Requirements**:
- Bending and Stooping = 80%
- Climbing = 40%
- Keyboard Entry = 80%
- Kneeling = 40%
- Lifting/Carrying Patients 35 Pounds or Greater = 0%
- Lifting or Carrying 0 - 25 lbs Non-Patient = 80%
- Lifting or Carrying 2501 lbs - 75 lbs Non-Patient = 60%
- Lifting or Carrying > 75 lbs Non-Patient = 0%
- Pushing or Pulling 0 - 25 lbs Non-Patient = 80%
- Pushing or Pulling 26 - 75 lbs Non-Patient = 60%
- Pushing or Pulling > 75 lbs Non-Patient = 40%
- Reaching = 80%
- Repetitive Movement Foot/Leg = 0%
- Repetitive Movement Hand/Arm = 80%
- Running = 60%
- Sitting = 80%
- Squatting = 80%
- Standing = 80%
- Walking = 80%
- Audible Speech = 80%
- Hearing Acuity = 80%
- Smelling Acuity = 60%
- Taste Discrimination = 0%
- Depth Perception = 80%
- Distinguish Color = 80%
- Seeing - Far = 80%
- Seeing - Near = 80%
- Bio hazardous Waste = 40%
- Biological Hazards - Respiratory = 40%
- Biological Hazards - Skin or Ingestion = 40%
- Blood and/or Bodily Fluids = 60%
- Communicable Diseases and/or Pathogens = 40%
- Asbestos = 0%
- Cytotoxic Chemicals = 80%
- Dust = 80%
- Gas/Vapors/Fumes = 60%
- Hazardous Chemicals = 80%
- Hazardous Medication = 80%
- Latex = 80%
- Computer Monitor = 80%
- Domestic Animals = 40%
- Extreme Heat/Cold = 0%
- Fire Risk = 40%
- Hazardous Noise = 0%
- Heating Devices = 60%
- Hypoxia
