Medication Access Specialist, Specialty Pharmacy

The Medication Access Specialist (MAS) is responsible for completing necessary functions to ensure timely medication access for high cost, self-administered or in-clinic administered medications. This role will provide resources to patient to minimize out of pocket cost while maximizing pharmacy reimbursement.

Essential Job Statements

• Reviews prescription for accuracy of prescribed treatment regimen, complete data entry of prescription, adjudicate pharmacy claims, and resolve adjudication errors and rejections. 

• Completes pharmacy benefits investigation and coordination, initiate and complete prior authorization approval and/or denials (appeals), track progress, and expedite responses from insurance carriers and payers. and coordinate additional assistance (as needed) with copay cards, grant funding, and patient assistance programs.   

• Participates in Specialty pharmacy call center activities and triage. The MAS is responsible for incoming calls from patients, payers, and providers to ensure pharmacy call response requirements are met for accreditation(s). 

• Facilitates adherence to medications by ensuring that patients receive prescribed medications in a timely manner. Document and triage patient problems with therapy to the appropriate pharmacist; assure documentation of problem and follow-up with patient and assist with coordination of filling. 

• Enhances medication access by preventing therapy interruptions due to insurance issues in conjunction with pharmacists, physicians, and clinic staff. Communicate and collaborate regarding patient therapy interruptions, additional therapy monitoring requirements, and alternative care delivery setting options.  

• Expedites resolution of delivery and dispensing problems that may occur to ensure continued medication access. 

• Participates in the Specialty pharmacy quality management committee. 

• Mentors/Trains Assists in the orientation and/or instruction of new employees in the role of MAS. 

• Works as a Pharmacy Technician when deemed necessary. 

Patient Population 

Demonstrates the knowledge and skills necessary to provide equitable care appropriate to the age of the patients served on their assigned unit.    

Demonstrates knowledge and related competencies of the principles of growth and development of the life span and possesses the ability to assess data reflective of the patient's status and interprets the appropriate information needed to identify each patient's requirements relative to their age, specific needs and to provide the equitable care needed as described in departmental policies and procedures. 

Neonates (0-4 weeks)  

Infant (1-12 months)  

Pediatrics (1-12 years)  

Adolescents (13-17 years)  

Adults (18-64 years)   

Geriatrics (65 years and older)

Employment Qualifications 

Required Education: 

High School Diploma or equivalent Education/training 

Preferred Education: 

Licensure/Certification Required: 

Current certification by the Pharmacy Technician Certification Board (PTCB) 

Current licensure with the Virginia State Board of Pharmacy By virtue of societal trust and security explicitly imparted to pharmacies for the control of drugs, candidate/incumbent must have a clean criminal record (i.e. no felony conviction; no drug or pharmacy related convictions, including misdemeanors); no denial, suspension, revocation, or restriction of registration or licensure by any State Board of Pharmacy Licensure, Certification, or Registration  

Licensure/Certification Preferred: 

Minimum Qualifications 

Years and Type of Required Experience 

Minimum of one (1) year previous pharmacy practice or Specialty pharmacy experience 

Minimum of one (1) year of customer service or call-center experience 

Other Knowledge, Skills and Abilities Required: 

Cultural Responsiveness 

Respond respectfully and effectively to people of all cultures, languages, classes, races, ethnic backgrounds, disabilities, religions, genders, sexual orientations, and other diversity factors in a manner that recognizes, affirms, and values their worth. 

Other Knowledge, Skills and Abilities Preferred: 

Minimum of one (1) year prior experience with prior authorizations, Patient Assistance Programs, and prior experience with prescription on-line adjudication.

Previous work experience using a personal computer and various billing software applications as well as e-mail, spreadsheets, word processing, databases, etc. 

Working Conditions 

 
Periods of high stress and fluctuating workloads