Medication Access Coordinator at AdventHealth Greater Orlando

Glendale Heights, Illinois, United States -

Full Time

Start Date

Immediate

Expiry Date

02 Feb, 26

Salary

0.0

Posted On

04 Nov, 25

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Attention To Detail, Organization Skills, Problem-Solving Skills, Customer Service Skills, Teamwork, Multitasking, MS Office Proficiency, Pharmacy Benefits Knowledge, Medical Terminology, Pharmaceutical Calculations, Prior Authorization Services, Patient Assistance Programs, Quality Management, Training And Education, Communication Skills, Data Analysis

Industry

Hospitals and Health Care

Description

All the benefits and perks you need for you and your family: Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance Paid Time Off from Day One 403-B Retirement Plan 4 Weeks 100%25 Paid Parental Leave Career Development Whole Person Wellbeing Resources Mental Health Resources and Support Pet Insurance Our promise to you: Joining UChicago Medicine AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. UChicago Medicine AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better. Schedule: Full Time Shift: Days; Monday - Friday 8:00am - 4:30pm Location: 701 Winthrop Avenue, Glendale Heights, IL 60139 The community you’ll be caring for: UChicago Medicine AdventHealth GlenOaks - MTM Clinic The role you’ll contribute: The Medication Access Coordinator is responsible for completing necessary functions to ensure optimal reimbursement for high cost, take home medications for patients receiving care in ambulatory clinics. Duties and responsibilities include: assistance with conducting and completing necessary third party prior authorization requests and associated services related to high cost medications, maximizing efficiency for patients and clinic staff. Other areas of responsibility include pre-screening patients for viable payment sources, managing reimbursement issues associated with high-cost medications, identifying opportunities for improving reimbursement from payers, compiling reports for contract optimization, completing the necessary paperwork for prior authorizations, and conducting retrospective utilization reviews on cases of payment denials or insufficient reimbursement. Participation in the quality management program is expected with the goal of improving services by monitoring processes, analyzing data, implementing interventions to improve and evaluating the effectiveness of those interventions. Responsibilities may include working to establish and maintain long- and short-term goals for the Quality Management Program; monitoring and documenting Quality Improvement Projects for progress in meeting quality improvement goals; and providing guidance and education to staff on Quality Management priorities and projects. The value you’ll bring to the team: Improves patient service experience and maximizes pharmacy revenue through provision of prior authorization services for high-cost medications. Completes prior authorization forms, negotiates authorization status with insurers, tracks prescription approval status, and alerts clinical pharmacists of denials or nonresponse. Facilitates enrollment of patients in patient assistance programs and collaborates with social services and case management. Assists pharmacists with preparing letters of medical necessity and coordinating peer-to-peer conferences. Expedites clinic workflow and enhances patient care by preventing therapy interruptions due to insurance issues in conjunction with pharmacists, physicians, and clinic staff. Communicates and collaborates regarding patient therapy interruptions, additional therapy monitoring requirements, and alternative care delivery setting options. Facilitates adherence to medications by ensuring patients receive prescribed medications in a timely manner and makes scheduled calls to obtain clinical information and process prescription refills. Documents and triages patient problems with therapy to the appropriate pharmacist, assures documentation of problem and follow-up, and assists with coordination of filling, packaging, and delivery of prescriptions. Observes and understands prescribing trends within ambulatory clinics to identify areas for improved specialty pharmacy contracting. Develops marketing materials and communication strategies under the guidance of the pharmacy management team to increase patient recruitment and prescription capture rate of high-cost take-home medications. Assists with the development and implementation of policies and procedures to ensure reimbursement of high-cost medications. Facilitates staff training and competency, education, and practice advancement, including training new staff members and coordinating with the manager to develop and maintain a training and competency program for specialty pharmacy technician staff. Performs other duties as assigned. Conducts patient insurance, benefits, and financial investigation and verification by directly communicating with patients. The expertise and experience you’ll need to succeed: High School Grad or Equiv Required Five or more years of Work Experience Required Experience with pharmacy benefits plans and secondary insurance providers (copay assistance). Accuracy and attention to detail for long periods of time; excellent organization skills. Ability to interpret prescription and knowledge of the generic names of medications and medical terminology; vast understanding of mathematical principles to perform pharmaceutical calculations. Ability to critically think through situations with good problem-solving skills Good customer service skills and values teamwork. Must be able to multitask and be flexible in moving from task to task within the department while maintaining composure and staying organized. Basic to moderate proficiency skill set in MS Office: Word, Excel and Outlook. Registered Pharmacy Technician (RPT-LIC) - Registered Pharmacy Technician in Illinois or Certified Pharmacy Technician by passing the PTCB or ExCPT pharmacy technician exam Required

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Responsibilities

The Medication Access Coordinator ensures optimal reimbursement for high-cost medications by managing prior authorization requests and reimbursement issues. They also participate in quality management programs to improve services and patient care.