Medication Access Specialist

J  o  b    D  e  s  c  r  i  p  t  i  o  n

JOB INFORMATION

Effective Date:

7/1/2023

Entity:

Wisconsin

Job Code:

700005

Job Title:

Medication Access Specialist

FLSA Exemption Status:

Non-Exempt

Management Level:

Individual Contributor

JOB SUMMARY

The Medication Access Specialist (MAS) improves patient access to medications by supporting the functions of inpatient and outpatient pharmacists. The Medication Access Specialist will be responsible for educating patients on UW Health retail pharmacy services, proactively obtaining payment information for patients using UW Health pharmacies, identifying opportunities for improving reimbursement from payers, documentation of activities on all applicable software platforms including the electronic health record, and providing an accurate clinical patient review. The incumbent will assist in training authorization functions and serve as a resource to other departments with questions regarding medication pre-certification. When an authorization cannot be obtained, the MAS must be able to guide and educate staff, providers, and/or patients on the options and necessary steps to resolve the barriers to obtaining necessary medications.

To efficiently manage requests, staff will anticipate and resolve the barriers to care to promptly resolve medication access requests. The MAS will independently plan, schedule, and organize numerous tasks as the position directly impacts hospital and physician reimbursement. A substantial portion of the normal duties of the incumbent requires proper judgment, sensitivity and strict adherence to UW Health policy on confidentiality.

ESSENTIAL DUTIES

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Verify patient third-party payer coverage and medication benefits/coverage policies

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Submit clinical information to third party payers to secure coverage for medications

•

Track workload of prior authorization requests from initial request through final insurance determination.

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Review and evaluate medication orders to ensure adherence to medication use policies and coverage

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policies of third-party payers

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Support providers and clinical staff in the navigation of, and adherence to, internal and external formulary policies, pathways, and step-therapy requirements to ensure appropriate and cost-effective medication use

•

Review and monitor documentation and coding practices for medication administration to support the medication reimbursement process including, but not limited to: assisting Accounts Payable and Fiscal departments in the coding of medications, supporting and advising medication denial reviews, and supporting providers on the submission of clinical information to support coverage denials through appeals processes.

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Identify alternate sources of funding or medication supply when required to facilitate patient access to appropriate therapies to prevent unnecessary healthcare utilization

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Collaborate with key stakeholders in the medication use process: identify and recommend alternate sites of care delivery when appropriate or required to ensure payment for services, and support physicians, pharmacists, and clinical staff in the development and alignment of medication use policies across care settings.

•

Prioritize workflows to determine appropriate timelines for clinical authorizations, proactively manage medication reauthorizations, and adhere to processes to ensure timely access to services.

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Work collaboratively with UW Health personnel to educate and inform patients about UW Health retail pharmacy services

As needed, additional responsibilities reasonably within the scope of duties and physical requirements may be assigned.  ALL DUTIES AND REQUIREMENTS MUST BE PERFORMED CONSISTENT WITH THE UW HEALTH PERFORMANCE STANDARDS AND RESPECT FOR PEOPLE COMMITTMENTS.

X

Non-Clinical

JOB REQUIREMENTS

High School Diploma

or equivalent

Required

Associate's Degree

in Health Science, Business or a related field

Preferred

1 year

of experience in a healthcare, business, finance, or insurance related field

Required

2 years

of experience in Healthcare Revenue Cycle that includes prior authorization

Preferred

2 years

of experience in preadmission/precertification

Preferred

Knowledge of CPT and ICD coding highly desired

Preferred

Knowledge of Medicare and third-party payer regulations and guidelines highly desired

Preferred

Wisconsin Pharmacy Technician Registration

Upon Hire

Required

Licensed Practical Nurse (LPN) or Certified Pharmacy Technician (CPhT)

Preferred

LICENSE, CERTIFICATIONS, AND REGISTRATIONS MUST BE MAINTAINED PER UW HEALTH POLICY. 

•

Maintains current knowledge of medical modalities as well as new protocols established for patient populations.

•

Solid understanding and knowledge of payer contractual requirements, registration workflows, and prior authorization requirements to ensure staff follow established procedures to maximize reimbursement and minimize write offs.

•

Excellent written and oral communication skills.

•

Maintains effective and cooperative working relationships with co-workers, leaders, clinical staff and the public.

•

Must be detail oriented and accurate.

•

Ability to multi-task and prioritize tasks.

•

Displays an aptitude and willingness to learn new responsibilities.

•

Willingly accepts feedback.

•

Flexible and innovative.

•

Ability to problem-solve and work independently.

•

Displays a professional appearance.

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Dependable and reliable in achieving goals.

•

Experience operating office machines such as personal computers, fax machines, photocopier, and document scanners.

•

Familiarity with medical terminology and abbreviations.

PHYSICAL REQUIREMENTS/WORKING CONDITIONS

☒

Sedentary: Ability to lift up to 10 pounds maximum and occasionally lifting and/or carrying such articles as dockets, ledgers and small tools. Although a sedentary job is defined as one, which involves sitting, a certain amount of walking and standing is often necessary in carrying out job duties. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Up to 10#

Negligible

Negligible

☐

Light: Ability to lift up to 20 pounds maximum with frequent lifting and/or carrying of objects weighing up to 10 pounds. Even though the weight lifted may only be negligible amount, a job is in this category when it requires walking or standing to a significant degree.

up to 20#

Up to 10# or requires significant walking or standing or requires pushing/pulling of arm/leg controls.

Negligible or constant push/pull of items of negligible weight

☐

Medium: Ability to lift up to 50 pounds maximum with frequent lifting and/or carrying objects weighing up to 25 pounds.

20-50#

10-25#

Negligible-10#

☐

Heavy: Ability to lift up to 100 pounds maximum with frequent lifting and/or carrying objects weighing up to 50 pounds.

50-100#

25-50#

10-20#

☐

Very Heavy: Ability to lift over 100 pounds with frequent lifting and/or carrying objects weighing over 50 pounds.

Over 100#

Over 50#

Over 20#

Other - list any other physical requirements or bona fide occupational qualifications not indicated above:

Over 50 lbs.

UW Health does not require, nor does it expect that its employees lift more than 50 lbs unassisted. Objects in excess of 50 lbs should be lifted or moved with mechanical means or through a team lift. Employees in patient care areas are expected to utilize mechanical lifts and adhere to the "Use of Mechanical Lifts (Liko)" policy in the Patient Services Policy and Procedure Manual.

Note: The purpose of this document is to describe the general nature and level of work performed by personnel so classified; it is not intended to serve as an inclusive list of all responsibilities associated with this position.

THE EMPLOYEE MUST BE ABLE TO COMPLETE ALL PHYSICAL REQUIREMENTS OF THE JOB WITH OR WITHOUT AN APPROVED ACCOMODATION. Note: The purpose of this document is to describe the general nature and level of work performed by personnel so classified; it is not intended to serve as an inclusive list of all responsibilities associated with this position.