University of Rochester Medication Access Specialist (Specialty) Corporate Woods - 236998 in Rochester, New York
Medication Access Specialist (Specialty) Corporate Woods Job ID 236998Location Strong Memorial Hospital Full/Part Time Full-Time Favorite Job Regular/Temporary Regular Opening
Full Time 40 hours Grade 008 Pharmacy SMHResponsibilities
The Medication Access Specialist (MAS) is responsible for the overall management of medication coordination and removal of barriers that prevent patients from receiving their specialty medications. Specialty medications are high cost medications that need more attention than a medication dispensed at a retail or community pharmacy. Duties will include communication with the prescriber’s office to acquire necessary information to submit prescriptions to the patient’s insurance for approval including prior authorization and helping enroll patients in financial assistance programs, and arrange timely delivery of the specialty medication. The MAS will link communication between the patient, pharmacist, insurance, and clinic staff to ensure coordinated care.
The MAS will be assigned a set of patients to manage along with a clinical pharmacist. Daily tasks are completed independently and prioritized based on the patient and pharmacist needs. Duties of this position require proper judgement, sensitivity, and strict adherence to Strong Memorial Hospital policy on confidentiality and the protection of Private Health Information. The MAS interacts with multiple individuals within the institution including, but not limited to, hospital and clinical employees at various levels including pharmacists, pharmacy technicians, medical/clinical staff, and central prior authorization staff. External interactions include third party payors, governmental peer review organizations, and referring physicians. To be successful, this individual must have excellent phone etiquette and be open to feedback to create strong collaborative work relationships.
SPECIFIC RESPONSIBILITIES: (Approximate time spent %)
Pharmacy Coordination (50%)
1.1 When enrolling patients in the specialty pharmacy program, the MAS will find the appropriate insurance information and financial assistance options for the high cost specialty drugs, and discuss this with the patient and/or family.
1.2 Make scheduled calls to patient to bill prescriptions and set up deliveries. Facilitate adherence to medications by ensuring that patients receive prescribed medications in a timely manner.
1.3 Provide excellent customer service through the Specialty Pharmacy Call Center. Triage patient calls to appropriate party. Answer incoming calls in a timely manner.
1.4 Clearly communicate with the pharmacy staff to make sure the medication and supplies are prepared quickly and accurately to be sent to patients to prevent treatment interruptions due to insurance issues in conjunction with pharmacists, physicians, and clinic staff.
1.5 Document and triage problems with the medication (i.e. delivery issues, side effects, adherence, difficulty with administration, etc.) to the pharmacist when appropriate; ensure documentation of problem, and follow-up with patient to ensure safe and effective medication use.
1.6 Communicate with inventory manager to notify what to order if the medication is special order or low volume. The MAS will also track changes in prescribing trends to alert inventory manager if changes in stock on hand is needed.
1.7 Review and report status of patient charge accounts once monthly by the first week of each month for previous month.
Patient Assistance Program Management (20%)
2.1 The MAS will be knowledgeable remain up-to-date on all potential patient assistance programs (PAP) relevant to the high-cost, specialty drugs prescribed in their assigned clinic(s).
2.2 Proactively assist patients that are receiving high-cost specialty medications for potential participation in PAPs, and identify the best option(s) for the patient given their overall circumstances (insurance, disease state, income, etc). This will often involve communicating with the patient and/or family to obtain necessary information which may include income information and other personal details, as well as to present PAP options to the patient/family when there are multiple options.
2.3 Enroll patients in PAPs using the needed permission and information, follow-up to determine the status of the application, and ensure proper documentation of this process.
2.4 Submit all required documentation to the PAP throughout the duration of treatment to verify payment for each prescription refill is still active.
2.5 Meet or discuss with the patient and/or family the status of PAP eligibility on an as-needed basis if coverage changes during treatment duration.
2.6 Serve as a general resource available to patients, providers and other clinic staff about PAPs.
2.7 Understand and manage the payment process specific to each PAP, and assure that payments are properly accounted for the correct patient and correct patient encounter.
2.8 Collaborate with social services and case management on patient assistance. Assist pharmacists with preparing letters of medical necessity and coordinating peer-to-peer conferences.
Prior Authorization Management (20%)
3.1 The MAS will be knowledgeable of the current policies of the most common payors for the relevant clinic-administered drugs that require prior authorization (PA), and will be responsible for working with the prior authorization coordinators, office staff nurses and other patient care staff to assure that all required elements of the policy are applicable in advance of requesting PA.
3.2 Improve patient service experience through facilitating the prior authorization services on behalf of clinics for specialty medications. Complete prior authorization forms, advocate for authorization approvals with insurers, track status of authorization approval, and when necessary, alert clinical pharmacists of denials or nonresponse.
3.3 If a letter of medical necessity or physician-to-medical director conversation is needed for approval outside of the payor policy, the MAS will notify the relevant provider and provide the physician with needed documentation and summary of actions taken to date.
3.4 Document all PAs in the appropriate location within the electronic medical record include the PA number and dates of approval.
3.5 Track all PAs to assure that they are renewed on a timely basis to prevent interruptions or delays in treatment.
Compliance and quality (10%)
4.1 Remain professional, courteous and diligent in all interactions with staff and patients/families.
4.2 Obtain high patient and provider satisfaction results on annual satisfaction survey.
4.3 Report errors through hospital error reporting system (RL solutions) and contribute to quality improvement initiatives.
4.4 Assist with prescription audits and ensure patients return signature logs.
4.5 Facilitate training for newly hired team members and competency, education and practice advancement.
4.6 Performs other related duties as required.
Capable of working independently with minimum supervision
Exhibit strong communication skills, problem-solving abilities, and a professional presentation
Demonstrate customer relations skills
Must meet one of the following criteria:
Associate’s degree in Medical, Secretarial or related field
Certified pharmacy technician (CPhT) and a minimum of three years of relevant experience
An equivalent combination of education and experience
NOTE: This document describes typical responsibilities and is not intended to limit management from assigning other work as required the possibility of other tasks or projects.
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How To Apply
All applicants must apply online.
EOE Minorities/Females/Protected Veterans/Disabled