Pharmacy Access Specialist

18 hours ago

Madison, Wisconsin, United States SSM Health Full time
Job Summary

We are seeking a highly skilled Pharmacy Access Specialist to join our team at SSM Health. In this role, you will play a critical part in improving patient access to medically necessary pharmaceuticals by managing patient insurance benefits and utilizing established patient assistance programs.

Key Responsibilities
  • Serve as a liaison between medical staff, outpatient pharmacies, insurance providers, and patients to enhance communication and continuity of care.
  • Review patient demographics, medication history, and insurance status to identify socioeconomic barriers, opportunities for intervention, and eligibility for prescription assistance.
  • Improve patient service experience through benefits investigations and prior authorization services, developing a thorough understanding of payer reimbursement and patterns for pharmacy and medical claims with third parties.
  • Serve as the primary ambulatory pharmacy resource to facilitate access to prescription and medical benefit medications, addressing formulary/coverage issues, copay issues, patient assistance program eligibility, and other indigent programs.
  • Coordinate services with internal patient care team members regarding patients with limited financial resources for paying for medications, facilitating medication access to support discharge preparations.
  • Interact with hospital and clinic employees, including pharmacists, clinical staff, fiscal personnel, department managers, access services staff, coding staff, and billing assistants, as well as external contacts such as third-party payers, manufacturers, prescription benefit management companies, external pharmacy personnel, and referring providers and their support staff.
  • Review complex insurance situations to educate patients, providers, and clinic staff on appropriate next steps to access prescription and medical benefit information.
Requirements
  • Bachelor's degree or equivalent years of experience and education.
  • No experience required.
Physical Requirements
  • Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs.
  • Frequent sitting, standing, walking, reaching, and repetitive foot/leg and hand/arm movements.
  • Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors.
  • Frequent use of hearing and speech to share information through oral communication, with the ability to hear alarms, malfunctioning machinery, etc.
  • Frequent keyboard use/data entry.
  • Occasional bending, stooping, kneeling, squatting, twisting, and gripping.
  • Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs.
  • Rare climbing.
Required Professional License and/or Certifications
  • Pharmacy Technician, Registered - Illinois Department of Financial and Professional Regulation (IDFPR).
  • Pharmacy Technician - Missouri Division of Professional Registration.
  • Or MO Registration Application and Fingerprint Process Complete AT TIME OF HIRE - Missouri Division of Professional Registration.
  • And FUTURE - Pharmacy Technician, Registered within 6 months - Missouri Division of Professional Registration.
Work Shift and Job Type

Day Shift (United States of America)

Employee

Department: 7721840164 WRO Pharmacy Access

Scheduled Weekly Hours: 40

SSM Health is an equal opportunity employer. SSM Health does not discriminate on the basis of race, color, religion, national origin, age, disability, sex, sexual orientation, gender identity, pregnancy, veteran status, or any other characteristic protected by applicable law.

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