POSITION SUMMARY:

Under the direct supervision of the Medication Coordination Manager, the Medication Coordinator I will process and track all request for refills, prior authorizations, and patient assistance program. The Medication Coordinator I will perform their duties within the established standards of care, policies and procedures of APLA Health & Wellness.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Obtain prior authorizations (PA) for medications.
• Contact insurance carriers to verify medication eligibility and requirements.
• Request, track and obtain prior authorizations from insurance carriers. Facilitate appeals as needed.
• Request, and track medications requested via the patient assistance program.
• Communicate any insurance changes or trends among the team. Provide updates to local, state, & federal benefits. Gather feedback as provided and relay to program leads.
• Clearly document all communications and contacts with insurance companies, PBOs and pharmacies.
• Stay up to date on all avenues of medication access for patients, including public benefits and programs that may serve as payers of last resort. Evaluate patient candidacy appropriately. Facilitate enrollment of qualifying patients, coordinating with other team members if necessary.
• Complete and manage forms/applications to process medications via the Patient Assistant Program, delegate as appropriate.
• Maintain patients informed on status of patient assistance program, PAs approvals or denials and document in patients electronic health record.
• Process refill medications request
• Provide medication information and education to patients, following established protocols and guidelines.
• Document pertinent patient information following established protocols.
• Adheres to all OSHA PPE safety requirements.
• Maintain working knowledge of in-house pharmacy software platform in order to readily acquire prescription claims information.
• Perform data processing when working in pharmacy as typist or clerk.
• Participate in case conferences as needed.
• Will travel to other APLA Health sites as needed.

OTHER DUTIES MAY BE ASSIGNED TO MEET BUSINESS NEEDS.

REQUIREMENTS:

Training and Experience:

• High school diploma or GED.
• Current Medical Assistant certificate and/or California Pharmacy Technician certificate.
• Minimum one year experience evaluating eligibility, including both commercial and public benefits. 
• Experience working in a nonprofit ASO environment a plus; specific training/experience with HIV/AIDS-related issues a plus.

Knowledge of:

• Knowledge and experience working with target populations, including individuals who share injection paraphernalia, gay and non-gay identified men, youth, women, and transgender individuals a plus.
• HIPAA certified and knowledge of informed consent.
• Knowledge of medical terminology.
• Knowledge of MSDS and emergency treatments.

Ability to:

• Ability to use computerized patient care systems.
• Work in dependently with minimal direction.
• Work effectively with diverse staff, volunteers and professionals.
• Be at ease and work with a diverse group (ethnic, class, gender, sexual orientation) of individuals who may hold a wide range of opinions regarding prevention needs.
• Engage in community/coalition building.
• Multitask.
• Meet multiple deadlines in a rapidly changing environment
• Maintain patient confidentiality.
• Ensure that services have the following qualities: 1) nonjudgmental 2) are harm reduction focused 3) are sex positive 4) are LGBT positive.

WORKING CONDITIONS/PHYSICAL REQUIREMENTS:

This is primarily an office position that requires only occasional bending, reaching, stooping, lifting and moving of office materials weighing 25 pounds or less. The position

requires daily use of a personal computer and requires entering, viewing, and revising text and graphics on the computer terminal and on paper.

SPECIAL REQUIREMENTS:

Must possess a valid California driver’s license; proof of auto liability insurance; and have the use of a personal vehicle for work related purposes.

Some weekend/evening work may be required. Local travel (within LA County) is required, and some out-of-town and national travel may be required. COVID-19 and Booster or Medical/ Religious exemption required.

APLA Health is an Equal Opportunity Employer.

Salary : $26 - $29