What are the responsibilities and job description for the Medication Access Coordinator position at thedacare?
Why ThedaCare? Living A Life Inspired! Our new vision at ThedaCare is bold, ambitious, and ignited by a shared passion to provide outstanding care. We are inspired to reinvent health care by becoming a proactive partner in health, enriching the lives of all and creating value in everything we do. Each of us are called to take action in delivering higher standards of care, lower costs and a healthier future for our patients, our families, our communities and our world. At ThedaCare, our team members are empowered to be the catalyst of change through our values of compassion, excellence, leadership, innovation, and agility. A career means much more than excellent compensation and benefits. Our team members are supported by continued opportunities for learning and development, accessible and transparent leadership, and a commitment to work/life balance. If you’re interested in joining a health care system that is changing the face of care and well-being in our community, we encourage you to explore a future with ThedaCare. Benefits, with a whole-person approach to wellness – Lifestyle Engagement e.g. health coaches, relaxation rooms, health focused apps (Wonder, Ripple), mental health support Access & Affordability e.g. minimal or zero copays, team member cost sharing premiums, daycare About ThedaCare! Summary : The Medication Access Coordinator is responsible for coordinating the efforts around prior authorizations for medications billed through patients' pharmacy & medical benefits, patient assistance workflows, ensuring accurate billing and reimbursement for pharmacy services, and around the prescription refill workflows and protocol maintenance. The position will operate as a liaison between the Medication Access team, clinic leadership, clinical staff, providers, insurance providers and other involved parties to provide safe and efficient care to all patients impacted by the medication access team. Remote access may be required for timely work completion due to the time sensitivity around these services. Responsible for oversight of obtaining medication insurance coverage or assistance and benefit information, authorizations of medications, monitors patient's insurance status, assists in facilitating medication refill requests, and communicates insurance issues to the treatment team. Coordinates the day-to-day functions on the Medication access team to ensure timeliness of all services and ensure proper follow up is done by team members. Responsible for providing updates around medication access services to physicians, clinical staff, and pharmacy office, through multiple methods as appropriate (includes in services, email communication, one on one meetings). Coordinate the research, design, and implementation of practices and processes for medication access services. Other duties as assigned. Job Description: JOB RESPONSIBILITIES: Collaborates with both internal and external customers in responding to and resolving pharmacy-related inquiries from patients, providers, or pharmacists Participates in the coverage determination (certification, prior authorization, Exception to coverage, etc.) process by reviewing all requests which are approvable based on clinical criteria. Provides complete and accurate documentation specifying the rational for approval, and forwarding to the appropriate healthcare provider/clinician. Provide clinical expertise and support for commercial and government funded programs in the area of prior authorization, grievance, appeals and exceptions. Maintains a thorough understanding of Medicare and Medicaid guidelines and stay abreast of updates and changes through a variety of educational opportunities Demonstrates strong multitasking abilities to track and report utilization, practice patterns, and significant deviations for process improvement Proactively identifies uninsured and under insured patients and facilitates the enrollment process into manufacture assistance &co-pay assistance programs while applying funds to patient accounts to ensure cost avoidance for the Organization and patient access to medication therapy. Collaborates with pharmacists to review orders and related procedures/diagnoses to ensure the appropriateness and medical necessity of medication use based on established criteria Verify the accuracy of patient insurance information in Electronic Health Record system by communicating directly with insurance companies and patient financial services (PFS) Monitors medication receipt and dispensing of patients receiving medication through a co-pay assistance program or drug repository. Review monthly Medicare and other insurance write-offs to determine the reasons for the write-offs. Work with the Specialty Pharmacy Coordinator to implement proactive process to reduce and eventually eliminate write-offs. Proactively involves and communicates with pharmacy and multidisciplinary teams to coordinate patient assistance Documents in appropriate record keeping system in a timely and efficient manner to ensure appropriate record keeping and communication between collaborative teams. Acts as a liaison between the pharmacy and other clinical units within the health system. Develops and maintains positive relationships to promote the pharmacy medication services Job Standard 3: Administers the expected level of competence and skill in healthcare insurance and assistance programs, exhibits professional behavior, and supports the mission of pharmacy practice excellence and education. Influences situations around conflict/disagreement and demonstrates the ability to manages challenging situations in a manner to provide a quality experience Accountable for managing patient assistance and medication benefits and providing exceptional patient care. Prioritizes workload to meet patient and customer needs. Maintains competency in their practice area. Appropriately files and maintains pharmacy records in accordance with Wisconsin and Federal Law and departmental policy. Manages and completes all required audits (as assigned) Identifies quality improvement opportunities and provides constructive feedback. Actively collaborates to implement improvements to assure the excellence of departmental services. Represents the pharmacy department on committees, interdisciplinary groups, task forces and/or improvement teams as a pharmacy subject matter expert. Demonstrates effective problem-solving skills. Facilitates training fellow Medication Access Specialists and pharmacy extenders/learners in orientation to policies, procedures, and workflows Educates pharmacy and other FH staff on policies and procedures related to billing, reimbursement, and compliance Educates pharmacy and other FH staff regarding new and existing programs Provides a high level of customer service to all internal and external customers. Leads service recovery efforts in respective area if needed. Actively works to resolve customer concerns and manages difficult situations to promote a high level of customer satisfaction. Works within the department and individual groups to maintain a focus on common goals and service to the end customer (the patient). QUALIFICATIONS: EXPERIENCE REQUIRED: A minimum of 2 years’ experience as a Medication Access Specialist 2 (or similar experience). Cross trained and demonstrated ability to support prior authorization services in a minimum of 3 different disease states and/or demonstrated ability to support multiple clinics from a medication refill perspective and/or demonstrated ability to support all areas in regards to foundation and manufacture assistance. Cross trained and demonstrated competence in multiple medication access team responsibilities (such as prior authorizations, foundation and manufacture assistance, and medication refill support). Experience with 3rd party insurance. EXPERIENCE PREFERRED: None. EDUCATION REQUIRED: High school diploma or equivalent is required. EDUCATION PREFERRED: 4-year degree preferred. Graduate of ASHP accredited pharmacy tech training program preferred. SPECIAL SKILLS REQUIRED: Proven attention to detail. Exceptional customer service skills. Proven ability to communicate effectively with a diverse group. Outstanding organizational skills. Promotion skills ability to sell a program. Experience with various computer systems, programs, and insurance companies (such as EMR, retail pharmacy POS, web portals). Ability to independently facilitate new projects and work with a multidisciplinary group to achieve success. Aptitude for accomplishing goals with minimal supervision and working independently with efficiency and self-motivation. Critical thinking skills to improve upon current processes and suggest solutions to problems with the services. LICENSURE REQUIRED: Application for Wisconsin registration as a Pharmacy Technician is required by hire date and must be obtained within 12 months of hire. Certification as a Pharmacy Technician (CPhT) through passing the Pharmacy Technician Certification Boards exam (PTCE) or the National Health career Associations exam (ExCPT) is required within 6 months of hire. LICENSURE PREFERRED: None. QUALITIES: Ability to support, advance and live our mission and evidence of such: Mission – Our reason for Being - To advance the health of our communities through excellence and discovery, inspiring each person to live their unique best life Ability to support, advance and work toward our vision and evidence of such. Vision - Who we Aspire to be - To be your trusted partner, transforming health care for everyone every day Commitment to and evidence of demonstrating our guiding principles. Scheduled Weekly Hours: 40 Scheduled FTE: 1 Location: Corporate - 2300 E Capitol Dr - Appleton,Wisconsin Overtime Exempt: No Worker Shift Details: Days About ThedaCare ThedaCare is a community health system consisting of seven hospitals, numerous clinics and related services.We are the third largest health care employer in Wisconsin and the largest employer in the state's second largest economic market - Northeast Wisconsin - with approximately 6,800 employees. Through our 100-year history, ThedaCare has woven itself into the very fabric of the communities we serve. For our employees, ThedaCare offers an environment that not only welcomes but also encourages innovative thinking and fresh approaches to today’s health care challenges. We’ve improved the health of thousands of individuals. We know this because we track our quality and constantly seek to improve our care and services for the members of our communities. This job posting is available in other languages besides English free of charge. Please contact the ThedaCare Employment Center to make your request at 920-830-5800 and then prompt “1”. ThedaCare is an Equal Opportunity Employer. ThedaCare complies with applicable Federal civil rights laws and does not discriminate on the basis of race, ancestry, color, religion, sex, gender identity, age, marital status, sexual orientation, national origin, medical condition, disability, veteran status, or any other basis protected by law.