Medication Access Coordinator CPhT - Specialty Pharmacy

Specialty Pharmacy Medication Access Coordinator

Enhancing Patient Access to Specialty Medications

Job Overview:

Under the direction of the Specialty Pharmacy Clinical Manager and in collaboration with Clinical Pharmacists and the Dispensing Team, the Specialty Pharmacy Medication Access Coordinator plays a crucial role in ensuring timely medication access and financial assistance for TriHealth specialty pharmacy patients.

Key responsibilities include:

• Conducting pharmacy insurance benefit investigations
• Completing prior authorizations (PAs) for specialty medications
• Managing specialty prescription drug appeals
• Coordinating financial assistance enrollment (copay cards, patient assistance programs, etc.)
• Collaborating with providers, pharmacists, and the dispensing team to ensure timely access to specialty therapy
• By streamlining these processes, the MAC enhances the patient experience and maximizes pharmacy revenue.

Job Requirements:

✔️ Graduate of an approved technical, professional, or vocational program (or) Bachelor's/Associate’s Degree (equivalent experience accepted) ✔️ National Pharmacy Technician Certification (CPhT) (PCTB or ExCPT Certification) ✔️ Ohio Board of Pharmacy Certified Pharmacy Technician registration ✔️ 2-3 years experience in retail or specialty pharmacy, insurance verification, benefits, and eligibility investigations ✔️ Key Skills:

• Strong organizational and attention-to-detail abilities
• High integrity, dependability, and quality focus
• Empathetic and effective communicator/listener
• Discretion and confidentiality, handling sensitive patient data

Key Responsibilities:

✅ Building Strong Patient & Provider Relationships

• Engage with physicians, nurses, prescribers, and patients to improve pharmacy services
• Provide compassionate, culturally sensitive service
• Communicate professionally via phone, email, and in-person interactions

✅ Benefit Investigation & Prior Authorization (PA)

• Verify patient pharmacy insurance coverage and track down missing information
• Complete PA paperwork and manage incoming calls, faxes, and ePAs
• Ensure PA approvals and re-adjudicate prescriptions based on patient financial responsibility
• Set PA renewal reminders and notify patients of out-of-pocket costs

✅ Patient Assistance Program (PAP) & Financial Coordination

• Identify manufacturer-sponsored assistance programs for eligible patients
• Enroll patients in Health System or Specialty payment plans
• Secure refill prescriptions, address insurance concerns, and assist with appeals

✅ Operational & Compliance Excellence

• Manage patient requests, provider follow-ups, and medication adherence check-ins
• Track deliveries, reconcile electronically adjudicated claims, and monitor unpaid accounts
• Assist in Third-Party, Medicare, and Medical Provider claim audits
• Escalate high-risk financial cases for Pharmacy Leadership review

Working Conditions:

📍 Physical Requirements:

• Rarely: Climbing, kneeling, lifting 50+ lbs.
• Occasionally: Stooping, pulling, pushing, lifting 11-50 lbs.
• Frequently: Walking
• Consistently: Sitting, standing, reaching, use of hands, color vision

📍 Mental & Communication Demands:

• Consistently: Concentrating, continuous learning, hearing conversations, interpersonal communication, reading, thinking/reasoning
   

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: