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 may occur.  

General office environment.  
May be exposed to high noise levels and bright lights. 

May be exposed to limited hazardous substances or body fluids. * 

May be exposed to human blood and other potentially infectious MASerials. *   

May have periods of constant interruptions. 

* Individuals in this position are required to exercise universal precautions, use personal protective equipment and devices, and learn the policies concerning infection control. 

Physical Requirements   

Physical Demands: Lifting/ Carrying (0-50 lbs.), Push/ Pull (0-50 lbs.), Stoop, Kneel, Squat, Bending  

Work Position: Sitting, Walking, Standing  

Additional Physical Requirements/ Hazards    

Physical Requirements: Manual dexterity (eye/hand coordination), Perform shift work, Hear alarms/telephone/tape recorder, Reach above shoulder, Repetitive arm/hand movements, Finger Dexterity, Color Vision, Acuity - far, Acuity - near  

Hazards: Use of Latex Gloves, Exposure to moving mechanical parts, Exposure to high pitched noises

Mental/Sensory – Emotional     

Mental / Sensory: Strong Recall, Reasoning, Problem Solving, Hearing, Speak Clearly, Write Legibly, Reading, Logical Thinking 

Emotional: Fast-paced environment, Able to Handle Multiple Priorities, Frequent and Intense Customer Interactions, Noisy Environment, Able to Adapt to Frequent Change

The Medication Access Specialist improves revenue collection pertaining to high cost medications that require prior authorization. This job will initiate, follow-up, and proceed with approval and/or denials of prior authorizations efficiently via phone, fax, or electronically.

The Medication Access Specialist carries out benefit investigation and coordinates Patient Assistance Programs and/or copay cards for patients with high co-pays or those without insurance coverage. This role works closely with nursing and physicians in order to obtain required documentation for prior authorization and billing.

The Medication Access Specialist arranges refills, transfers, and delivery of medications. Updates patient case management system regularly. Ideally, this role is familiar with disease state terminology or willingness to research. This role also works as a Pharmacy Technician when deemed necessary.

Licensure, Certification, or Registration Requirements for Hire: 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 Requirements for continued employment: Current certification by the Pharmacy Technician Certification Board (PTCB) Current licensure with the Virginia State Board of Pharmacy Experience REQUIRED: Minimum of one (1) year previous pharmacy practice experience in a similar setting Minimum of three (3) years prior experience with Manufacturers 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. Experience PREFERRED: N/A Education/training REQUIRED: High School Diploma or equivalent Education/training PREFERRED: Associates Degree in Business or related field from an accredited program Independent action(s) required: Identifies equipment problems; various aspects of assisting the pharmacist that don’t require a pharmacist's supervision or check. Supervisory responsibilities (if applicable): N/A Additional position requirements: Able to work all shifts, weekends, holidays, emergency coverage Age Specific groups served: N/A Physical Requirements (includes use of assistance devices as appropriate): Physical: Lifting less than 20 lbs. Activities: Prolonged standing, Prolonged sitting, Frequent bending, Walking (distance), Climbing (steps, ladder, other), Reaching (overhead, extensive, repetitive), Repetitive motion Mental/Sensory: Strong recall, Reasoning, Problem solving, Hearing, Speak clearly, Write legibly, Reading, Logical thinking Emotional: Fast pace environment, Steady pace, Able to handle multiple priorities, Frequent and intense customer interactions, Noisy environment, Able to adapt to frequent change

Workday Day (United States of America)

EEO Employer/Disabled/Protected Veteran/41 CFR 60-1.4.