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 medications and restricted access drugs within designated clinics.

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

The overarching goal of this program is to enhance access to clinic-administered medications while optimizing revenue and 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 requirements. A significant portion of the responsibilities necessitates sound judgment, sensitivity, and strict adherence to confidentiality policies and the protection of Private Health Information.

The incumbent will interact with various stakeholders both within and outside the institution, including hospital and clinical personnel at multiple levels, such as pharmacists, medical staff, fiscal personnel, department managers, access services staff, coding staff, and billing assistants. External contacts 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 comprehensive knowledge of current policies from major payers regarding clinic-administered drugs requiring prior authorization (PA) and ensure all necessary elements are met before requesting PA.
  • Take the lead in submitting PA requests to payers for clinic-administered medications and manage any supplemental information requests.
  • Analyze all PA denials to understand the reasons behind them and prepare appropriate responses with necessary additional information. Engage relevant clinic staff or providers as needed, providing a summary of actions taken along with supporting documentation.
  • Inform the relevant provider and supply necessary documentation and summaries if a letter of medical necessity or a physician-to-medical director conversation is required for approval outside of payer policy.
  • Document all PAs accurately in 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 up-to-date knowledge of all potential patient assistance programs (PAP) relevant to high-cost, clinic-administered medications used in assigned clinics.
  • Evaluate each patient receiving high-cost, clinic-administered drug therapy for potential participation in PAPs, identifying the best options based on their circumstances (insurance, disease state, income, etc.). This often involves meeting with patients and/or families to gather necessary information and present multiple PAP options.
  • Enroll patients in PAPs according to the specific requirements of each program, ensuring approval and proper documentation in the electronic medical record.
  • Submit all required documentation to the PAP throughout treatment to ensure payment for each administered dose and continued coverage for maximum assistance.
  • For governmental payers where PAPs may provide no-cost drugs from external pharmacies/distributors, manage patient-specific inventory for administration on treatment days and ensure documentation is adequate to suppress any patient charges for the medication.
  • As necessary, communicate with patients and/or families regarding the status of PAP eligibility 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 drugs 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 correctly applied to the appropriate patient and encounter.
  • If necessary, set up the PAP 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 payment from the PAP, 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 overall drug management processes.
  • 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 candidate must be capable of working independently with minimal supervision. Strong communication skills, problem-solving abilities, and a professional demeanor are essential. 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 to Learn, Discover, Heal, Create - and Make the World Ever Better.

In alignment with our values and those of society, 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 our policies, admissions, employment, access, and recruitment of candidates from underrepresented populations, veterans, and persons 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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