Medication Access Specialist

Role Summary and Duties

The Medication Access Specialist focuses on proactively reviewing patients' medication insurance benefits to ensure reimbursement criteria are met. This includes processing medication test claims, completing third-party prior authorization requests, educating patients regarding outpatient pharmacy services, collecting payment details, and accurately documenting patient medication histories. The specialist also manages patient assistance programs and coordinates activities related to specialty medication orders.

Collaboration and Support

This role collaborates closely with hospital and clinic teams such as medical staff, pharmacists, technicians, nurses, social workers, and case managers. Under pharmacy leadership guidance, the specialist supports inpatient and outpatient pharmacy functions to improve patient access to medications.

Key Responsibilities

• Review and verify patient drug coverage using electronic medical records and pharmacy systems.
• Assess prescribed medications across the health system and facilitate insurance and financial reviews to promote timely medication adherence.
• Maximize revenue by securing authorization for costly take-home medications via third-party payers.
• Enhance outpatient pharmacy revenue and patient service by handling test claims and prior authorization procedures.
• Educate patients and families on outpatient pharmacy benefits and services.
• Assist hospital discharge patients in acquiring medications, including direct patient interaction.
• Support pharmacists by entering and verifying prescription and patient data, preparing medications, and ensuring compliance with safety protocols.
• Manage cash register sales and handle cash transactions.
• Help maintain workflow and scheduling for pharmacists.
• Support inventory management: ordering, unpacking, verifying, storing pharmaceuticals, and reporting shortages.
• Adhere to reporting procedures for prescription errors and comply with quality improvement guidelines.
• Deliver excellent customer service by assisting and engaging actively with patients.

Compliance and Standards

• Meet performance, satisfaction, and financial standards as per evaluations.
• Follow all employee handbook compliance requirements and departmental policies.
• Promote a positive and respectful workplace in accordance with behavioral standards.
• Maintain safety for patients, visitors, and staff by recognizing and mitigating risks.
• Utilize electronic communication, attendance, and learning management systems as required.
• Adhere strictly to all applicable DCH Health System policies and procedures.

Qualifications and Experience

• Registration as a pharmacy technician in Alabama required at start date.
• National certification by PTCB or ExCPT mandatory.
• Minimum one year experience in medication reimbursement and healthcare insurance preauthorization.
• Preferred: Three years’ pharmacy practice experience and familiarity with patient assistance programs.
• Baccalaureate degree highly preferred.
• Proficient computer skills, including Microsoft Office applications.
• Strong verbal communication and interpersonal skills.
• Ability to work efficiently under pressure and meet deadlines.
• Detail-oriented with effective follow-up and strong telephone etiquette.
• Good foundational knowledge of medications and medication classes.

Working Conditions

• Ability to stand, walk, reach, sit, crouch, and stoop for prolonged periods.
• Capacity to lift up to 35 pounds.
• Manual dexterity and coordination for handling pharmacy tasks.
• Effective communication with a diverse patient and staff population.
• Physical presence in the workplace mandatory.
• Normal or corrected vision and hearing required.
• Must be able to perform essential duties with or without reasonable accommodation.