Access Specialist, Specialty Pharmacy
Navitus Health Solutions LLC Madison, WI
- Posted: over a month ago
Under the direction of Supervisor, Specialty Pharmacy Services and pharmacists in the Specialty Pharmacy, the Access Specialist is primarily responsible for performing duties to assist patients with access to benefits, copay cards, patient assistance programs or foundations. The Access Specialist will work directly with patients, providers, insurance companies and manufacturers to review all opportunities for financial assistance for specialty medications. The Access Specialist may assist in the scheduling of delivery of prescriptions provided through the specialty pharmacy, and assist any other area in the facility as needed with regard to pharmacy technician type duties.
- Serve as the liaison between the pharmacy, insurance providers and patient in order to provide accurate and effective communications regarding financial assistance options and resources. All efforts aim to offer high touch quality, patient care.
- Obtain, review and document patient demographics, medication history, and insurance status to identify socioeconomic barriers, opportunities for intervention and eligibility for prescription assistance
- Improve patient service experience through the provision of benefits investigations and conducting review of all opportunities for coverage of specialty medications.
- Develop a thorough understanding of payer reimbursement and patterns for pharmacy claims with third parties.
- Serve as a primary pharmacy resource to facilitate access to prescription medications. Including but not limited to; formulary/coverage issues, copay issues, patient assistance program eligibility, and other programs available.
- Interact with external entities including but not limited to third party payers, manufacturers, prescription benefit management companies, external pharmacy personnel, and referring providers and their support staff.
- Review complex insurance situations in order to educate patients, providers, and clinic staff on how to follow appropriate next steps to get access to prescription and medical benefit information
- The Employee will act in accordance with all applicable federal and state laws and with the highest ethical standards that we consistently strive to achieve. Thus, legal and ethical compliance is an essential duty of each employee.
- Perform other duties as assigned as requested by Supervisor
- Minimum High School Diploma or equivalent; Preferred Associate Degree in Health Science, Business or a related field
- One (1) year of experience in a healthcare, business, finance, or insurance related field. Preferred
- Wisconsin Employees -Certified CPhT or ExCPT preferred
- Arizona Employees – Must be a licensed pharmacy technician or pharmacy technician trainee in the state of AZ. Must attain CPhT certification, through PTCB or ExCPT, and pharmacy technician license through the state board of pharmacy within 3 years
- The ability to consistently interact cooperatively and respectfully with other employees.
- Participate in, adhere to, and support compliance program objectives.
- Solid understanding and knowledge of payer contractual requirements, registration workflows, and prior authorization requirements to ensure staff follow established procedures to maximize financial outcome
- Excellent written and oral communication skills.
- Maintains effective and cooperative working relationships with co-workers, leaders, clinical staff and the public.
- Must be detail oriented and accurate.
- Ability to multi-task and prioritize tasks.
- Displays an aptitude and willingness to learn new responsibilities
- Willingly accepts feedback.
- Flexible and innovative.
- Ability to problem-solve and work independently.
- Displays a professional appearance.
- Dependable and reliable in achieving goals.
- Familiarity with medical terminology and abbreviations.
- Proficient level of software proficiency in using PC software to support activities
- Work tasks are performed indoors. Temperature is moderate and controlled.
- Must be able to sit for extended periods of time
- Requires grasping, writing, standing, sitting, walking, repetitive motions, listening and hearing ability and visual acuity.
- Talking and hearing occur continuously in the process of communicating with customers and other employees.
- Vision occurs continuously with the most common visual functions being those of near vision and depth perception.
- Requires manual dexterity to use and operate all necessary equipment.
- All employees must maintain a neat, clean, and well-groomed appearance and dress in a manner appropriate in a professional environment.
Navitus Health Solutions LLC
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