Join our dynamic team at TriHealth as a Specialty Pharmacy Medication Access Coordinator. Under the guidance of the Specialty Pharmacy Clinical Manager and in collaboration with our Clinical Pharmacists and Dispensing Team, you will be pivotal in coordinating medication access and financial assistance for our specialty pharmacy patients. Your responsibilities will include conducting pharmacy insurance benefit investigations, completing prior authorizations (PAs), handling specialty prescription drug appeals, and enrolling eligible patients in financial assistance programs. Your efforts will enhance the patient experience and maximize pharmacy revenue by ensuring timely access to specialty medication therapy and providing support to providers and clinical pharmacists.
Location: 4623 Wesley Ave, Cincinnati, OH 45212
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, and enrolling eligible patients in financial assistance programs (copay cards, patient assistance programs, etc.). The MAC improves the patient experience and maximizes pharmacy revenue by ensuring timely access to specialty medication therapy and assisting with miscellaneous coordination and follow-up with providers and clinical pharmacists.
Work Hours:
Full-time, 80 hours bi-weekly Days Now weekends or holidays commitmentJob Requirements:
Graduate of an approved technical, professional, or vocational program or Bachelor's Degree, Associates Degree. Equivalent experience accepted in lieu of degree. Organized, high-integrity, attention to detail, dependable, quality-focused, empathetic, and a good listener/communicator. Discretion and confidentiality are essential as the position deals with highly sensitive and private data. National Pharmacy Technician Certification (CPhT) is required. The current approved examinations are the Pharmacy Technician Certification Board (PTCB) or ExCPT Certification by the National Health career Association. Must be registered with the Ohio Board of Pharmacy as a Certified Pharmacy Technician. 2-3 years of experience in Retail Pharmacy or Specialty Pharmacy, or work experience in insurance verification, benefits, and eligibility investigations.Job Responsibilities:
Develop and maintain strong relationships with physicians, prescribers, nurses, and patients to build the service. Provide caring service, adjusting approaches to reflect cultural differences of the population served. Professionally and compassionately manage and resolve difficult situations involving patients. Respond politely and professionally to pharmacist/nursing/physician/patient or other requests via telephone, in writing, or in person. Appropriately manage, triage, and ensure timely follow-up of all requests. Clearly articulate ideas and thoughts through written and verbal communications.Benefit Investigation & Prior Authorization (PA):
Pull new prescriptions from the queue. Verify that the pharmacy has the patient’s current pharmacy insurance coverage information and track down missing information. Complete required PA paperwork. Manage incoming calls, faxes, and ePAs related to pharmacy prior authorizations. Ensure that the PA is approved and re-adjudicate prescriptions revealing patient’s financial responsibility. Document PA renewal terms and schedule applicable reminders. Call patients to inform them of their financial responsibility.Patient Assistance Program (PAP):
Refer to the specialty list of manufacturer-sponsored assistance programs and suggest options for patients as applicable. Enroll patients in Health System or Specialty payment plans or send them to Patient Accounts (dependent on the system). Document PAP renewal terms and schedule applicable reminders.Other Duties:
Communicate with patients and respective team members to fill prescriptions when PA and PAPs are complete. Refer cases requiring clinical review to a Pharmacist or Medical Provider. Provide resolution to grievances and appeals issues. Ensure that patients remain on track with medication regimens, medication adherence check-ups, and secure refill prescriptions. Communicate effectively with the clinical pharmacists and dispensing team. Answer patient questions about the service, insurance issues, etc., in a timely and accurate manner. Provide customer service to patients by conducting inbound and outbound calls to schedule the delivery of medications. Track packages to ensure patients receive medication in a timely manner. Facilitate adherence to medications by ensuring that patients receive prescribed medications in a timely manner. Develop and maintain positive customer relations and coordinate with various functions within TriHealth to ensure customer requests and questions are handled appropriately and in a timely manner. Enter and maintain accurate prior authorization and patient assistance program records. Complete all necessary paperwork, forms, records, and electronic documentation according to policies, procedures, and regulations. Ensure compliance with regulatory requirements and organizational policies and procedures. Collaborate and act as liaison with patients, family, clinical pharmacists, and the dispensing pharmacy team. Perform 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 costs. Provide thorough, accurate, and timely responses to requests from pharmacy operations and/or patients regarding benefit information. Assess and establish whether patients need co-pay assistance. Provide guidance to healthcare providers and patients in connection with documentation required for payer coverage, support with appeals for denied claims, and follow up with payers to determine outcomes. Ensure that electronically adjudicated claims are reconciled and paid for prior to delivery. Follow up on all unpaid claims and aging A/R items. Participate in Third Party, Medicare, and Medical Provider claim audits to minimize financial exposure. Evaluate and escalate “at risk” accounts to Pharmacy Leadership for review for financial exposure or write-off. Document and submit requests for Patient Refunds when appropriate. Manage 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 - FrequentlyTriHealth 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 Job keywords: Accredited Pharmacy Technician, Certified Pharmacy Technician (CPhT), Chemotherapy Pharmacy Technician (Chemo Pharmacy Technician), Compounding Technician, OR Pharmacy Tech (Operating Room Pharmacy Tech), RPhT (Registered Pharmacy Technician), Retail pharmacy, Ouptatient pharmacy