Pharmacy Medication Access Coordinator

Pharmacy Medication Access Coordinator

Coordination of medication access alongside ambulatory specialty clinics providers, nurses and pharmacy staff in accordance with any accreditation and Texas State Board of Pharmacy laws and standards within the Pharmacy Department. Adheres to the implementation of standards, processes and systems to enhance quality, efficiency, and timeliness of responsibilities. Serves as a medication access specialist and resource to interdisciplinary staff & patients. Responsible for ensuring accurate submission, documentation and review of prior authorizations, patient assistance programs and appeals as assigned. Utilizes understanding of prescription payor guidelines relative to medication access for patient population. Ensures adherence to reimbursement standards and optimal customer service satisfaction. Consistently demonstrates the core values of Children's Health System of Texas and serves as a role model to other employees.

Responsibilities:

• Utilizes basic pharmaceutical knowledge to ensure accurate completion of daily responsibilities impacting patient care.
• Possesses the ability to complete pharmaceutical calculations to ensure accuracy in medication coverage submission.
• Serves as preceptor for on-boarding new team members to the department.
• Provides guidance, feedback and training to staff on multiple processes, third-party payors and adjudication systems; monitoring work queue assignments and assess productivity.
• Possesses the ability to interpret and demonstrates compliance with performance standards, regulations and policies and procedures and third-party contracts, guidelines.
• Coordinates the implementation of team-oriented process improvement initiatives for the department and organization.
• Resolves complex patient issues, responds to questions on reimbursement and serves as a resource to patient access specialists as needed, including on-the-job training.
• Acts as liaison to resolve complex patient medication authorization issues.
• Clerical functions include but are not limited to the management of phone lines, faxing, documentation of information received by phone or fax, retrieval of medical records, scanning of documents and other clerical functions not listed.
• Collect insurance benefit information from insurance representative or web portal resources to make determination of insurance benefits and coverage options.
• Continually communicate with and advocate for patients and families, providers, multidisciplinary team members and payors to facilitate coordination of submission and appeals.
• Punctual notification to physicians, clinical staff and patients regarding requested information from payor regarding medication authorizations to reduce approval delays. (i.e. Peer to Peer, letter of medical necessity, document signatures)
• Demonstrates the components of the Children's Health System Vision, Mission and The Children's Way Values.
• Follows all safety rules while on the job, reports accidents promptly and corrects minor safety hazards.
• Performs all other duties as assigned.

Work Experience:

• At least 2 years customer service experience with two years of healthcare experience including insurance verification and/or billing required
• At least 2 years acceptable knowledge of policies and guidelines utilized by all categories of health insurance companies, government agencies employer benefits departments as they relate to medication prior authorizations preferred
• Less than 1 year EPIC proficiency preferred

Education:

• Two-year Associate's degree or equivalent experience referred

Licenses and Certifications:

• Texas State Board of Pharmacy Certified Pharmacy Technician Licensure 1 Year preferred

A Place Where You Belong:

We put our people first. We welcome, value, and respect the beliefs, identities and experiences of our patients and colleagues. We are committed to delivering culturally effective care, creating meaningful partnerships in the communities we serve, and equipping and developing our team members to make Children's Health a place where everyone can contribute.

Holistic Benefits – How We'll Care for You:

• Employee portion of medical plan premiums are covered after 3 years
• 4%-10% employee savings plan match based on tenure
• Paid Parental Leave (up to 12 weeks)
• Caregiver Leave
• Adoption and surrogacy reimbursement

As an equal opportunity employer, Children's Health does not discriminate against employees or applicants because of race, color, religion, sex, gender identity and expression, sexual orientation, age, national origin, veteran or military status, disability, or genetic information or any other Federal or State legally-protected status or class. This applies to all aspects of the employer-employee relationship including but not limited to recruitment, hiring, promotion, transfer pay, training, discipline, workforce adjustments, termination, employee benefits, and any other employment-related activity.