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Pharmaceutical Access Consultant

2 months ago

Saint Paul, Minnesota, United States Visante Full time
Job Overview

ABOUT VISANTE
Visante is a dedicated consulting organization that aims to assist healthcare facilities in enhancing their clinical, operational, and financial outcomes through pharmacy optimization. Our expert team possesses extensive knowledge and innovative strategies to improve every facet of a fully integrated health system pharmacy program, delivering substantial value promptly.

ROLE SUMMARY (Remote, work from home)
We are seeking a Medication Access Specialist to join our Specialty Pharmacy Services division. This role is pivotal in delivering medication access and affordability solutions to our clients and their patients.

Key Responsibilities:

  • Evaluate medication authorizations submitted by clients.
  • Take appropriate actions based on the needs of clients and patients, which includes:
    • Determining the necessary steps for authorization submissions.
    • Reviewing essential documentation in the client's medical records for authorization.
    • Conducting benefits investigations to assess patient coverage and out-of-pocket expenses.
    • Identifying patient assistance programs, copay cards, grants, or funds to alleviate financial burdens.
    • Engaging with clinics to gather additional information or guidance for prior authorization submissions.
    • Assisting clinics in appealing coverage denials.
  • Communicate determinations and necessary follow-ups with patients on behalf of clients, including:
    • Providing information on medication coverage and financial assistance options.
    • Offering pharmacy alternatives for prescription fulfillment.
  • Ensure accurate and timely documentation of services rendered to clients and their patients by appropriately recording information in clients' EMR systems, following the agreed-upon workflows, and tracking prior authorization volumes and associated fees in Visante systems.
  • Support clients in onboarding and training their medication access specialists, as directed, and assist Visante in ongoing process enhancements and client-specific workflow development.
  • Collaborate with Visante team members and leadership to provide insights and constructive feedback on daily operations.
  • Assist clients in optimizing clinical staff and pharmacy workflows and communications.
  • Perform additional duties as assigned by the supervisor.

Qualifications:

  • Required:
    • High school diploma or equivalent.
    • 3-5 years of experience in healthcare or with pharmacy providers focusing on medication access.
  • Preferred:
    • Prior consulting or client-facing experience.
    • Familiarity with electronic medical record documentation and prior authorization processes.
    • Experience in retail pharmacy PBM adjudication.
    • Proficiency in using CoverMyMeds for prior authorization submissions.
    • Two years of experience in healthcare revenue cycle, specifically with medication authorizations.
    • Knowledge of CPT and ICD coding is highly desirable.
    • Understanding of Medicare and third-party payer regulations is preferred.
    • Two years of experience in preadmission/precertification processes.

Skills and Abilities:

  • Exhibit sound judgment, multitasking abilities, and meet deadlines with urgency while prioritizing competing demands.
  • Strong interpersonal, client relationship, and teamwork skills.
  • Proven problem-solving abilities with strong analytical and creative thinking.
  • Ability to make informed and timely decisions based on analysis and experience.
  • Clear and effective verbal and written communication skills, with a professional approach to advising clients.
  • Maintain confidentiality of all patient-related information.
  • Comprehensive knowledge of medication reimbursement and healthcare prior authorization/coding.
  • Proficient in MS Word, Outlook, PowerPoint, and Excel.

FOR MORE INFORMATION
Visante is an equal-opportunity employer committed to fostering a diverse and inclusive workplace. We value our employees as our greatest asset and strive to maintain an environment free from discrimination, harassment, and violence.

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