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Specialist in Medication Access

2 months ago

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

POSITION SUMMARY:


The Medication Access Specialist is accountable for the comprehensive oversight of drug accessibility for high-cost specialty and restricted access medications within designated clinics.

Key responsibilities encompass collaboration with clinical personnel to secure prior authorizations for pertinent providers, conducting benefit investigations, enrolling patients in suitable patient assistance initiatives, managing the vendor payment processes associated with these programs, and working closely with patient financial services to ensure precise billing for patient self-pay obligations.

This program aims to enhance access to clinic-administered medications while optimizing revenue and profit margins related to the provision of these high-cost drugs through effective supply chain management within the University of Rochester.

The role necessitates independent planning and organization to meet daily operational requirements. A significant portion of the responsibilities demands sound judgment, sensitivity, and strict compliance with confidentiality policies and the safeguarding of Private Health Information.

The specialist will engage with various stakeholders both within and outside the institution, including hospital and clinical staff at multiple levels such as pharmacists, medical personnel, financial staff, department heads, access services teams, coding experts, and billing assistants. External interactions will involve third-party payers, governmental peer review organizations, and referring physicians. To be successful, the individual must cultivate strong collaborative relationships.



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), ensuring that all necessary policy elements are addressed prior to PA requests.
  • Take lead responsibility for submitting PA requests to payers for clinic-administered medications and managing any supplemental information submissions.
  • Analyze all PA denials to ascertain reasons for denial and prepare responses to payers with the required additional information. Engage relevant clinic staff or providers as necessary, providing a summary of actions taken and supporting documentation.
  • Inform the relevant provider and supply necessary documentation and action summaries if a letter of medical necessity or physician-to-medical director conversation is required for approval beyond payer policy.
  • Document all PAs accurately within 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.
  • Evaluate each patient receiving high-cost drug therapy for potential participation in PAPs, identifying optimal options based on individual circumstances (insurance, disease state, income, etc.). This may involve direct meetings with patients and/or families to gather necessary information and present multiple PAP options.
  • Facilitate patient enrollment in PAPs according to each program's requirements, ensuring approvals are documented in the electronic medical record.
  • Submit all necessary documentation to the PAP throughout treatment to guarantee payment for each administered dose and ensure maximum assistance coverage.
  • For governmental payers where PAPs may provide no-cost drugs from external pharmacies/distributors, manage patient-specific inventories for treatment days and ensure appropriate documentation to avoid patient charges for medications.
  • As needed, communicate with patients and/or families regarding PAP eligibility status changes during care.
  • Act 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 with patients and/or families.
  • Understand and manage the payment processes specific to each PAP, ensuring accurate application of payments to the correct patient and encounter.
  • Set up PAPs within the electronic medical record revenue application as secondary or tertiary payers when necessary.
  • Collaborate with Patient Financial Services to hold patient bills pending PAP payments, ensuring 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 no-cost drug distributions 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 of learning, discovery, healing, and creativity.

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 legally protected status.

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.

Pay Range

Pay Range:
$25.77 Hourly

The referenced pay range represents the minimum and maximum compensation for this position.

Individual annual salaries/hourly rates will be determined based on factors including, but not limited to, market data, education, experience, qualifications, expertise, and internal equity considerations.