Specialist in Medication Access Management

2 weeks ago

Rochester, New York, United States University of Rochester Full time

POSITION SUMMARY:


The Medication Access Specialist plays a crucial role in overseeing the management of access to high-cost specialty and restricted medications within designated clinics.

This position involves collaborating with clinical personnel to secure prior authorizations for pertinent providers, conducting benefit investigations, enrolling patients in suitable patient assistance programs, managing vendor payment processes for these programs, and working alongside patient financial services to ensure accurate billing for patient self-pay responsibilities.

The overarching goal of this program is to enhance access to clinic-administered medications while optimizing revenue and profit margins associated with the provision of these high-cost drugs through effective supply chain management within the University of Rochester.

This role requires independent organization and planning to meet daily operational demands. A significant portion of the responsibilities necessitates sound judgment, sensitivity, and strict compliance with the University of Rochester's policies regarding confidentiality and the safeguarding of Private Health Information.

The incumbent will engage with various individuals both within and outside the institution, including hospital and clinical staff at multiple levels, such as pharmacists, medical professionals, financial personnel, department managers, access services staff, coding specialists, and billing assistants. External interactions will include third-party payers, governmental peer review organizations, and referring physicians. Establishing strong collaborative relationships is essential for success in this role.



SPECIFIC RESPONSIBILITIES:

A. Management of Prior Authorizations

  • Possess in-depth knowledge of current policies from major payers regarding clinic-administered drugs requiring prior authorization (PA), and work closely with clinic providers, nurses, and other patient care staff to ensure all necessary policy elements are addressed prior to PA requests.
  • Take primary responsibility for submitting PA requests to payers for clinic-administered medications and managing any supplemental information submissions as required.
  • Review all PA denials to ascertain the reasons for denial and prepare responses to payers with the necessary additional information. Engage relevant clinic staff or providers as needed, providing a summary of actions taken and supporting documentation.
  • Inform the relevant provider and supply them with necessary documentation and a summary of actions taken if a letter of medical necessity or physician-to-medical director discussion is required for approval outside of payer policy.
  • Document all PAs in the appropriate section of the electronic medical record, including PA numbers and approval dates.
  • Monitor all PAs to ensure timely renewals, preventing treatment interruptions or delays.

B. Management of Patient Assistance Programs

  • Maintain comprehensive knowledge of potential patient assistance programs (PAP) relevant to high-cost, clinic-administered medications utilized in assigned clinics.
  • Evaluate every patient receiving high-cost, clinic-administered drug therapy for potential participation in PAPs, identifying the most suitable options based on their circumstances (insurance, disease state, income, etc.). This often involves direct engagement with patients and/or families to gather necessary information, including income details and to present multiple PAP options.
  • Facilitate patient enrollment in PAPs using the required mechanisms for each program, ensuring approval and proper documentation in the electronic medical record.
  • Submit all necessary documentation to the PAP throughout the treatment duration to ensure payment for each administered dose and continued coverage for maximum assistance.
  • For governmental payers where PAPs may involve no-cost drugs from external pharmacies/distributors, manage patient-specific inventory to ensure availability for treatment days and ensure appropriate documentation to eliminate any patient charges for the medication.
  • As needed, communicate with patients and/or families regarding PAP eligibility status if circumstances change during care.
  • Serve as a resource for patients, providers, and clinic staff regarding PAPs.

C. Financial Management

  • Conduct benefits investigations for high-cost, clinic-administered medications as part of the patient intake process, discussing patient obligations for treatment with patients and/or families.
  • Understand and manage the payment processes specific to each PAP, ensuring payments are accurately applied to the correct patient and encounter.
  • If necessary, ensure that the PAP is established within the electronic medical record revenue application as a secondary or tertiary payer.
  • Collaborate with Patient Financial Services to ensure patient bills are held pending PAP payments, and that final bills accurately reflect patient obligations after PAP payments are received.

D. Financial Reporting

  • Track all payments received from PAPs, providing monthly, quarterly, and annual reports summarizing patient out-of-pocket savings attributed to PAP payments.
  • Monitor all no-cost drugs received for patients with governmental payers, quantifying savings realized by patients or the institution on a monthly, quarterly, and annual basis.

E. Patient and Provider/Clinic Satisfaction

  • Maintain professionalism, courtesy, and diligence in all interactions with staff and patients/families.
  • Regularly collect patient satisfaction survey data to assess high patient satisfaction and the overall drug management process.
  • Perform other related duties as required.

REQUIREMENTS:


An Associate's degree in a Medical, Secretarial, or related field, or certification as a pharmacy technician (PTCB) with a minimum of three years of relevant experience is required; or an equivalent combination of education and experience.

The ability to work independently with minimal supervision is essential. Strong communication skills, problem-solving abilities, and a professional demeanor are mandatory. Familiarity with medical terminology, experience with medical/surgical scheduling software, and electronic medical records are preferred. Demonstrated customer relations skills are also required.


The University of Rochester is dedicated to fostering a culture of equity, diversity, and inclusion to advance its mission of learning, discovery, healing, and creation.

In alignment with these values, the University is committed to non-discrimination based on age, color, disability, ethnicity, gender identity or expression, genetic information, marital status, military/veteran status, national origin, race, religion/creed, sex, sexual orientation, citizenship status, or any other status protected by law.

This commitment extends to the administration of policies, admissions, employment, access, and recruitment of candidates from underrepresented populations, veterans, and individuals with disabilities, consistent with these values and government contractor Affirmative Action obligations.


How To Apply
All applicants must apply online.

_EOE Minorities/Females/Protected Veterans/Disabled_

Pay Range

Pay Range:
$25.77 Hourly

_The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job's compensation range, determined by factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations._

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