NI-Specialist, Medication Access

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

JOB INFORMATION

Effective Date:

3/18/2025

Entity:

Illinois

Job Code:

NI-7178AC

Job Title:

NI-Specialist, Medication Access

FLSA Exemption Status:

Non-Exempt

JOB SUMMARY

The Medication Access Specialist (MAS) is a position residing in the Pharmacy Department. The MAS aids patients in a variety of activities to ensure optimal patient care and safety. This individual is responsible for completing necessary functions to ensure optimal reimbursement for medications at UW Health Northern IL, positively impacting access to medications.  Areas of responsibility may include:  triaging incoming calls, providing support to pharmacists and clinical staff through participation in benefits investigations, the prior authorization process for medications, working with patients to manage medication payment and reimbursement, supporting operations for in-person and virtual visits in a clinic setting, retrieving clinical data from the electronic health record as it pertains to the provision of patient care, and supporting departmental initiatives related to patient compliance and workflow optimization.    The Medication Access Specialist will also be responsible for other duties as assigned. 

ESSENTIAL DUTIES

•

Demonstrate proficiency in the use of the electronic health record, as well as pharmacy software to perform daily tasks

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Perform essential functions of scheduling/rescheduling patient visits where applicable, checking patients in/out of in-person and virtual visits where applicable, and managing incoming calls and faxes

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Responsible for reviewing and evaluating outpatient take home medications to assure the appropriateness and medical necessity of medication use based on established criteria. Obtain prior authorization from intermediaries and payers, including managed care companies, insurance companies, and review organizations. Ensure completion of activities that maximize revenue capture for high-cost medications

•

Responsible for conducting prospective prior authorizations services to expedite clinic workflow and enhance patient care by preventing therapy interruptions due to insurance paperwork issues

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Communicate with patients and/or families to market and educate potential patients on the existence and value in providing services at and following discharge

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Perform benefits investigation for potential medications for patient when appropriate and as requested by pharmacists and other care providers. Advise patient and/or family, patient’s family, pharmacist, or other care provider of coverage and estimated co-payment

•

Initiate and facilitate the prior authorization process, if required. Effectively and independently coordinate applications for federal, governmental, and/or private sector grants or patient assistance programs, if required

•

Conduct insurance reviews for appropriateness of therapy initiation and/or continuation with recommendations for additional labs as necessary

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Provide education and training for pharmacists on insurance-related issues and the tools/resources that are available to address these issues

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Educate new pharmacists on processes, providing information on discharge, commonly encountered insurance-related issues, and tools and resources that are available when medication-related problems are encountered at discharge

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Attend and participate in staff meetings

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

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

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 GED.

Required

One (1) year of experience in a healthcare, business, finance, or insurance related field.

Required

One (1) year of experience as a pharmacy technician in a hospital or retail pharmacy environment

Preferred

Current Pharmacy Technician licensure from State of Illinois or license eligible.

Required

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

•

Ability to use computers and a variety of programs including word processing, database management, and spreadsheets.

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Excellent written and oral communication skills.

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

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Must be detail oriented and accurate.

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Ability to multi-task and prioritize tasks.

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Displays an aptitude and willingness to learn new responsibilities.

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Willingly accepts feedback.

•

Flexible and innovative.

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Ability to problem-solve and work independently.

•

Knowledge of medication reimbursement and healthcare insurance prior authorization/coding.

•

Ability to demonstrate proficiency in chart review and navigation of an electronic health record.

PHYSICAL REQUIREMENTS/WORKING CONDITIONS

Standing

X

Walking

X

Climbing

X

Bending

X

Crouching

X

Pushing / Pulling

X

Carry

X

Fine Hand / Eye Coordination

X

Color Discrimination

X

Hearing Ability

X

Lifting / Lowering 1 -15 lbs.

X

15 - 30 lbs.

X

30 - 50 lbs.

X

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.

Concentration on Detail

X

Attention Span of 1 + Hours on a Task

X

Ability to Remember Multiple Tasks

X

Oral Communication

X

Written Communication

X

Exposure to Blood and Body Fluids

X

Exposure to Toxins, Cytotoxins, Poisons

X

Exposure to Extreme Heat, Cold, Temp Fluctuations

X

Exposure to Hazardous Chemicals

X

Exposure to Radiation

X

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.