In-Clinic Medication Access Specialist

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.

We are seeking a proactive and patient-centered In-Clinic Medication Access Specialist to join our Neurology care team at the Lahey Neuro Clinic, located at 29 Mall Road (BVH). In this vital on-site role (Monday through Friday), you will serve as the key liaison between neurologists, patients, and pharmacy services—ensuring timely and streamlined access to critical medications, including complex therapies for conditions such as multiple sclerosis, epilepsy, migraines, and movement disorders.

As part of your responsibilities, you will proactively review provider appointment lists and patient chart notes to identify individuals who may benefit from pharmacy support. You will work closely with our Medication Authorization and Access team to triage patient cases efficiently and support the coordination of insurance approvals and financial assistance. Additionally, you will act as a resource for neurology providers, addressing questions related to medication access and helping remove barriers to care. Your work will directly contribute to improved medication adherence and better health outcomes for our patients.

Job Description:

Essential Responsibilities:

1. Serves as a subject matter expert for physicians, administrators, clinical staff, pharmacy staff, and third party payers for issues regarding prior authorization approvals, ambulatory infusion reimbursement and Patient Assistance programs.

2. Collects and reviews all data needed for pharmacy and medical prior authorization approvals. Provides formulary assistance for clinic administered or infusion medications through evaluating necessity of prior authorization and identification of formulary alternatives.

3. Obtains initial and renewal insurance authorization for infusion medications as required by insurance plans and provide infusion cost estimates to patients or clinic staff.

4. Facilitates patient enrollment in available programs, handles customized communications, ensures ongoing claims processing accuracy and efficient delivery throughout the treatment period with a high-touch, member centric process and manages plan reporting.

5. Manages enrollment and services under the Employee Variable Co-Pay Program by reducing employee and plan sponsor costs and minimizing compliance risks. Assists patients with various forms of financial assistance by serving as a patient advocate to communicate and coordinate with drug manufacturers, PBMs and dispensing pharmacies.

6. Provides exceptional customer service to internal and external customers; resolves any patient requests in a timely and accurate manner; escalates complaints accordingly; maintains frequent phone contact with patient, provider and pharmacy staff; and clarifies prescription orders with pharmacist and/or clinician as appropriate.

7. Serves as the direct patient and provider contact for pharmacy benefits information, clinical and program information. Coordinates services with providers, specialty pharmacies and national account managers to improve turnaround time for patients.

8. Manages multiple strategic initiatives simultaneously and reprioritize where necessary, independently and effectively resolves complex accounts, and determines methods and procedures on new or special assignments with minimal supervision.

9. Networks with key payor and manufacture contacts inside and outside own area of expertise.

10. Provides training and support to inter-departmental associates. Cross cover other primary care and specialty clinics as needed.

Required Qualifications:

High School diploma or GED required.

Pharmacy Technician (Massachusetts) - Massachusetts Board of Pharmacy

3-5 years related work experience required in specialty pharmacy and medical prior authorization experience or a minimum of 4 years of pharmacy work experience.

Working knowledge of Common Procedural Terminology (CPT), Health Care Procedural Coding System (HCPCS) J Codes and International Classification of Diseases (ICD-10).

Experience with medical buy & bill and specialty clinic authorization management.

Must obtain PACS certification within twelve months of hire.

Experience with computer systems required, including web based applications and some Microsoft Office applications which may include Outlook, Word, Excel, PowerPoint or Access.

Preferred Qualifications:

Prior lead or supervisor experience. Familiarity with 340B drug program.

Deep knowledge of medication use in MS, RA, GI, transplant, hepatitis C, infectious disease (including HIV), and/or oncology a plu