Pharmacy Access Specialist

It's more than a career, it's a calling

WI-SSM Health West Beltline

Worker Type:

Regular

Job Highlights:

At SSM Health, we know the healing power of presence begins with compassionate employees like you.  As a Pharmacy Access Specialist, you’ve chosen a career where patients matter—a lot.  The Pharmacy Access Specialist plays an integral role in our care team, and we see it as a partnership.  Our mission and values put the patient first and place you in a position to improve each day.

In return, you can expect a work environment where employees feel valued, respected, and free to express themselves; each employee finds meaning in work, leveraging skills, and talents toward a greater purpose; teamwork and collaboration are encouraged, while management is supportive.

• Department: Pharmacy Access
• Schedule: Full Time, Day Shift, Mon-Fri 8am-4:30pm.
• No Weekends
• Starting Pay: 23.86 (Offers are based on years of experience and equity for this role.)
• Shift Differentials: Evenings-1.50, Nights-2.25, Weekends 2.15
• Location: SSM Health West Beltline – Madison, Wisconsin

If each patient’s needs, wants, and goals matter to you… then we’d love to learn more! Please fill out your application today. 

Job Summary:

Increase patient access and adherence to medically necessary pharmaceuticals by managing patient’s insurance benefits and utilizing established patient assistance programs. Provides value-added services by developing client-based relationships with clinical staff and patients, presenting pharmacy service options through customized financial analysis, and facilitating information gathering for program enrollment (patient assistance and indigent programs).

Job Responsibilities and Requirements:

PRIMARY RESPONSIBILITIES

• Serves as the liaison between the medical staff, outpatient pharmacies, insurance providers and patients to improve communication and continuity of care.
• Review patient demographics, medication history, and insurance status to identify socioeconomic barriers, opportunities for intervention and eligibility for prescription assistance.
• Improves patient service experience through the provision of benefits investigations and conducting prior authorization services. Develops a thorough understanding of payer reimbursement and patterns for pharmacy and medical claims with third parties.
• Serves as primary ambulatory pharmacy resource to facilitate access to prescription and medical benefit medications. Including but not limited to; formulary/coverage issues, copay issues, patient assistance program eligibility, and other indigent programs.
• Coordinates services with appropriate departments and internal patient care team members regarding patients who have limited financial resources for paying for medications and facilitates medication access to support discharge preparations.
• Interacts with hospital and clinic employees, including but not limited to pharmacists, clinical staff, fiscal personnel, department managers, access services staff, coding staff, and billing assistants. External contacts include but are not limited to third party payers, manufacturers, prescription benefit management companies, external pharmacy personnel, and referring providers and their support staff.
• Reviews complex insurance situations in order to educate patients, providers, and clinic staff on how to follow appropriate next steps to get access to prescription and medical benefit information. 
• Performs other duties as assigned.

EDUCATION

• Bachelor's degree or equivalent years of experience and education

EXPERIENCE

• No experi