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
The Medication Access Specialist is a dedicated member of the Pharmacy Department team who is responsible for assuring the financial viability of patients as they flow through the continuum of care. Acts as the liaison between patient, physician office, pharmacy, insurance providers, and other third parties to initiate and resolve appeals, as needed Acts as a liaison between patients, foundations, manufactures or necessary parties, to obtain financial prescription assistance for patients in need. Responsible for 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.
Job Description:
JOB RESPONSIBILITIES:
Reviews electronic medical record for patients to collect any pertinent information needed to submit, appeal, and resolve prior authorizations and medication refills requests (such as diagnoses, past medical history, past prescription history, and other information)
Assists in obtaining updated prescription authorization for existing patients
Assists the physician's office in obtaining and completing any and all documentation necessary to complete prior authorization and medication refill requests
Updates the patient, physician's office, any necessary parties through multiple methods as appropriate (include telephone, in-basket messaging, and electronic medical record), regarding responses and outcomes of prior authorizations and medication refills
Requires appropriate follow up with physician's office and any necessary parties in regards to status of prior authorizations and medication refill requests
Read, interpret, and effectively communicate information from insurance documents, electronic medical records, patient charts
Effectively participate in both written and verbal communication through multiple means (such as electronic health record, in basket messages, phone calls, emails, etc.)
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 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).
Problem solves as needed within a timely manner
Effective time management of tasks and responsibilities.
The ability to discern when it is appropriate to hand off tasks
Detail oriented with ability to effectively and efficiently multi-task.
Ability to work in a team environment.
Other duties as assigned.
QUALIFICATIONS:
EXPERIENCE: 3 years of experience in pharmacy, healthcare, managed care, or other health insurance environment is required. Knowledge of health insurance and pharmacy insurance benefit verification, health insurance terminology, billing, managed care contracting, hospital reimbursement, and hospital admitting and registrations practices required.
EDUCATION: High school diploma or equivalent is required. 4-year degree preferred. Graduate of ASHP accredited pharmacy tech training program preferred.
SPECIAL SKILLS: Proven attention to detail. Experience with third party insurance and medication/co-pay assistance programs. Effective interpersonal skills, including the ability to develop collaborative alliances, promote teamwork and ensure a high degree of internal and external customer satisfaction. Outstanding organizational and follow-up skills. Experience with various computer systems and programs (such as EPIC, insurance portals, McKesson Enterprise, etc.). Quick learner Ability to work independently and take programmatic initiative. Ability to function in a fast paced and changing environment and balance multiple priorities. Experience with navigating an Electronic Health Record.
LICENSURE: Certification through Pharmacy Technician Certification Board or National Healthcare Association (ExCPT) Required within the first 6 months of hire.
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
