Pharmacy Access Specialist

1 week ago


Menomonee Falls, Wisconsin, United States Froedtert Health Full time
Job Summary

The Medication Access Specialist is a key member of the Pharmacy Department team, responsible for ensuring the financial viability of patients throughout their care continuum. This role serves as a liaison between patients, physicians, pharmacies, insurance providers, and other third parties to initiate and resolve appeals as needed. The Medication Access Specialist is also responsible for obtaining medication insurance coverage or assistance and benefit information, authorizations of medications, and monitoring patient insurance status. They assist in facilitating medication refill requests and communicate insurance issues to the treatment team.

Responsibilities
  • Acts as a liaison between patients, physicians, pharmacies, insurance providers, and other third parties to initiate and resolve appeals as needed.
  • Obtains medication insurance coverage or assistance and benefit information.
  • Authorizes medications and monitors patient insurance status.
  • Assists in facilitating medication refill requests.
  • Communicates insurance issues to the treatment team.
  • Reviews electronic medical records for patients to collect pertinent information needed to submit, appeal, and resolve prior authorizations and medication refill requests.
  • Assists in obtaining updated prescription authorization for existing patients.
  • Updates patients, physicians, and other necessary parties regarding responses and outcomes of prior authorizations and medication refill requests.
  • Effectively participates in written and verbal communication through multiple means, including electronic health records, in-basket messages, phone calls, and emails.
Requirements
  • A minimum of 3 years of experience in pharmacy, healthcare, managed care, or other health insurance environments.
  • Knowledge of health insurance and pharmacy insurance benefit verification, health insurance terminology, billing, managed care contracting, hospital reimbursement, and hospital admitting and registration practices.
  • High School diploma or equivalent required; 4-year degree preferred.
  • Graduate of ASHP-accredited pharmacy tech training program preferred.
Perks & Benefits

Froedtert Health offers a variety of perks and benefits to staff, including paid time off, growth opportunities, academic partnerships, referral bonuses, retirement plans, medical, dental, and vision insurance, and employee assistance programs.



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