Medication Access Coordinator - Specialty Pharmacy

Medication Access Coordinator

At TriHealth Specialty Pharmacy, Medication Access Coordinators play a critical role in ensuring patients receive timely, affordable access to specialty medications. In this position, you'll go beyond traditional pharmacy tasks to become an advocate for patientsnavigating insurance benefits, prior authorizations, appeals, and financial assistance programs that directly impact patients' ability to start and stay on therapy.

Working closely with clinical pharmacists, providers, and the dispensing team, you'll be part of a collaborative, mission-driven environment where attention to detail, empathy, and follow-through truly matter. TriHealth values integrity, confidentiality, and professionalism, and provides a supportive setting where experienced pharmacy technicians can use their skills to improve the patient experience while contributing to the success and growth of specialty pharmacy services.

If you enjoy problem-solving, working with insurance and benefits, and making a meaningful difference for patients with complex medication needs, this role offers long-term stability, professional respect, and the opportunity to grow your impact within a trusted health system.

Location: Norwood, OH

Work Hours: Full time, 80 hours biweekly Day Shift Monday - Friday

Incentives & Benefits: We offer competitive shift differentials, opportunities for professional growth, and a comprehensive benefits package that may include medical, dental, vision, paid time off, retirement savings plans, and tuition reimbursement.

Minimum Qualifications:

• High School Diploma or GED (Required)
• Graduate of an approved technical, professional or vocational program or Bachelor's Degree, Associates Degree Equivalent experience accepted in lieu of degree (Preferred)
• 2 - 3 years' Experience in Retail Pharmacy or Specialty Pharmacy, or work experience in insurance verification, benefits, financial assistance, and eligibility investigations. Will accept Certified Pharmacy Technicians, Medical Assistants, and LPNs (Required)
• 3 - 4 years Certified Pharmacy Technician with previous Specialty Pharmacy Experience (Preferred)
• Proficiency with operating systems (Word, Excel, Outlook) and basic computer skills. Discretion and confidentiality are essential, as position deals with highly sensitive and private data.
• If Pharmacy Technician: National Pharmacy Technician Certification (CPhT) is preferred at hire. Approved certification is through Pharmacy Technician Certification Board (PCTB) and ExCPT Certification by the National Healthcareer Association. Preferred
• Pharm Tech must be registered with the Ohio Board of Pharmacy as a Certified Pharmacy Technician within 1 Year Required

Job Overview: Under the direction of the Specialty Pharmacy Clinical Manager and in collaboration with the Clinical Pharmacists and Dispensing Team, the Specialty Pharmacy Medication Access Coordinator (MAC) will coordinate medication access and financial assistance for TriHealth specialty pharmacy patients. This includes performing pharmacy insurance benefit investigations; completing specialty pharmacy prior authorizations (PAs); coordinating specialty prescription drug appeals; coordinating specialty medication financial assistance enrollment (copay cards, patient assistance programs, etc.) for eligible patients; assisting in the miscellaneous coordination and follow up with providers and clinical pharmacists and dispensing team to ensure timely access to specialty medication therapy. The MAC improves the patient experience and maximizes pharmacy revenue.

Job Responsibilities:

• Develops and maintains strong relationships with physicians, prescribers, nurses, and patients to build the service. Provides caring service, adjusting approaches to reflect cultural differences of population served. Professionally and compassionately manages and resolves difficult situations involving patients. Responds politely and professionally to pharmacist/nursing/physician/patient or other requests via telephone, in writing, or in person. Appropriately manages, triages, and ensures timely follow-up of all requests. Clearly articulates ideas and thoughts through written and verbal communications.
• Benefit Investigation & Prior Authorization (PA): Pulls new prescriptions from the queue. Verifies that the pharmacy has patient's current pharmacy insurance coverage information. Tracks down missing information. Completes required PA paperwork. Manage incoming calls, faxes and ePAs related to pharmacy prior authorizations. Ensures that the PA is approved and re-adjudicates prescription revealing patient's financial responsibility. Documents PA renewal terms and schedule applicable reminders. Calls patient to inform them what they are responsible for paying. Patient Assistance Program (PAP): Refers to the specialty list of manufacturer-sponsored assistance programs and suggest options for patient as applicable. Enrolls patient in Health System or Specialty payment plan or send to Patient Accounts (dependent on system). Document PAP renewal terms and schedule applicable reminders. Other Duties: When PA and PAPs are complete, communicates with patient and respective team members to fill the prescription(s). Refers cases requiring clinical review to a pharmacist or Medical Provider. Provides resolution to grievances and appeals issues. Ensures that patients remain on track with medication regimens, medication adherence check-ups, and secures refill prescriptions. Communicates effectively with the clinical pharmacists and dispensing team. Answers patient questions about the service, insurance issues, etc. in a timely and accurately manner Provides customer service to patients by conducting inbound and outbound calls to schedule delivery of medications. Tracks packages to ensure patient receives medication in a timely manner.
• Facilitate adherence to medications by ensuring that patients receive prescribed medications in a timely manner. Develops and maintains positive customer relations and coordinates with various functions within TriHealth to ensure customer requests and questions are handled appropriately and in a timely manner. Enters and maintains accurate prior authorization and patient assistance program records. Completes all necessary paperwork, forms, records, and electronic documentation according to policy and procedures and regulations. Ensures compliance with regulatory requirements and organizational policies and procedures. Collaborate and act as liaison with patient, family, and clinical pharmacists and dispensing pharmacy team.
• Performs full benefits verification on patients, including contacting payers to investigate and verify the terms and benefits of patient's insurance policies as well as patient cost. Provide thorough, accurate and timely responses to requests from pharmacy operations and/or patients regarding benefit information. Assesses and establishes whether patient needs co-pay assistance. Provides guidance to healthcare providers and patients in connection with documentation required for payer coverage, support with appeals for denied claims, and follow up with payer to determine outcome. Assists to ensure that electronically adjudicated claims reconciled and paid for prior to delivery. Follows up on all unpaid claims and aging A/R items. With Pharmacy Leadership, participates in Third Party, Medicare, and Medical Provider claim audits in order to minimize financial exposure. Evaluates and escalates "at risk" accounts to Pharmacy Leadership for review for financial exposure or write off. Documents and submits requests for Patient Refunds when appropriate. Manages time effectively by proactively prioritizing daily tasks, issue resolution, and work requests.

Other Job-Related Information:

• Demonstrates attention to detail in completing tasks and communication with patients and healthcare providers on the phone.
• Ability to efficiently complete multiple daily work assignments while operating independently.
• Ability to work cross-functionally to solve problems and improve quality and service.
• Knowledge of medical and pharmaceutical terminology and pharmaceutical patient assistance programs.
• Demonstrated experience in customer service with strong interpersonal and communication skills.

Working Conditions: Climbing - Rarely Concentrating - Consistently Continuous Learning - Consistently Hearing: Conversation - Consistently Interpersonal Communication - Consistently Kneeling - Rarely Lifting <10 Lbs. - Occasionally Lifting 50+ Lbs. - Rarely Lifting 11-50 Lbs. - Rarely Pulling - Occasionally Pushing - Occasionally Reaching - Occasionally Reading - Consistently Sitting - Consistently Standing - Consistently Stooping - Occasionally Thinking/Reasoning - Consistently Use of Hands - Consistently Color Vision - Consistently Walking - Frequently

TriHealth SERVE Standards and ALWAYS Behaviors At TriHealth, we believe there is no responsibility more important than to SERVE our patients, our communities, and our fellow team members. To achieve our vision and mission, ALL TriHealth team members are expected to demonstrate and live the following:

Serve : ALWAYS Welcome everyone by making eye contact, greeting with a smile, and saying "hello" Acknowledge when patients/guests are lost and escort them to their destination or find someone who can assist Refrain from using cell phones for personal reasons in public spaces or patient care areas Excel : ALWAYS Recognize and take personal responsibility to address and recover from service breakdowns when a customer's expectations have not been met Offer patients and guests priority when waiting (lines, elevators) Work on improving quality, safety, and service Respect : ALWAYS Respect cultural and spiritual differences and honor individual preferences. Respect everyone's opinion and contribution, regardless of title/role. Speak positively about my team members and other departments in front of patients and guests. Value : ALWAYS Value the time of others by striving to be on time, prepared and actively participating. Pick up trash, ensuring the physical environment is clean and safe. Be a good steward of our resources, using supplies and equipment efficiently and effectively, and will look for ways to avoid waste. Engage : ALWAYS Acknowledge wins and frequently thank team members and others for contributions. Show courtesy and compassion with customers, team members and the community