Medication Access Specialist

Description About CLS Health CLS Health is a growing healthcare system in Houston, Texas that is taking a different approach to healthcare. We are a physician-led healthcare group that focuses on providing patients with holistic, multispecialty care. We're a dynamic team on a mission to provide better healthcare options for Houstonians! Position Summary Owns the end-to-end access process for specialty and infused medications across the infusion center and pharmacy. The right candidate knows the drugs, the payers, and the manufacturer programs, and can get a medication from order to first treatment with no gaps. Responsibilities: Receive and review medication orders from referring providers Complete benefits investigation (medical vs pharmacy benefit) and determine coverage and patient financial responsibility Determine routing for each order: buy and bill through the infusion center or specialty pharmacy, based on payer requirements Submit and follow prior authorizations through payer and portal workflows, including appeals and peer-to-peer coordination Enroll patients in copay card programs, manufacturer portals, foundation assistance, and patient assistance programs (PAP) for free drug Coordinate medication sourcing with the pharmacy and distributor and confirm product and biosimilar selection per payer formulary Schedule initial treatments and hand off to clinical staff Track authorization expirations and reauthorizations Benefits: 401(k) matching Dental Insurance Disability insurance Health insurance Life insurance Paid time off Requirements 3+ years in medication access, prior authorization, or specialty pharmacy intake, preferably in an infusion or specialty clinic setting Working knowledge of J-codes, biosimilars, buy and bill, specialty pharmacy, and medical vs pharmacy benefit Hands-on experience with copay assistance portals, manufacturer hub programs, and PAP applications Familiarity with major commercial, Medicare Advantage, and Medicaid payer policies for specialty drugs Strong organization and follow-through; comfortable managing a high volume of open cases Pharmacy technician certification or similar is a plus #J-18808-Ljbffr CLS