Demo

Medication Access Specialist - Home Infusion Services

Visante Inc.
Saint Paul, MN Full Time
POSTED ON 2/8/2025 CLOSED ON 5/4/2025

What are the responsibilities and job description for the Medication Access Specialist - Home Infusion Services position at Visante Inc.?

Job Type

Full-time

Description

ABOUT THE POSITION

The Medication Access Specialist is a vital member of the managed services team, working under the direction of the Visante leadership team to effectively navigate the complexities of insurance benefits. This role is focused on enhancing medication access and alleviating financial burdens for patients. As a liaison among pharmacies, clinic staff, and insurance providers, the specialist plays a crucial role in optimizing treatment initiation and elevating overall patient satisfaction.

Key responsibilities include reviewing medication authorizations, conducting benefits investigations, and identifying patient assistance programs. The specialist will gather information for prior authorizations, assist with coverage denials, and communicate medication options and financial resources to patients. They will monitor insurance status, report access issues to the treatment team, and collect necessary insurance benefit details to effectively adjudicate medication claims.

This position emphasizes collaboration with team members and leadership to enhance operational efficiency and improve clinical workflows, ultimately contributing to Visante's mission of facilitating patient access to necessary medications.

WORK LOCATION AND TRAVEL

This is a remote, full-time salaried position with minimal travel requirements.

Job Responsibilities

  • Review of medication authorizations submitted by client
  • Perform appropriate actions based on client and patient needs, including :
  • Identify the process to submit authorizations
  • Review documentation in the client's medical record that is required for authorization submissions
  • Perform benefits investigation reviews to determine patient coverage and out-of-pocket costs
  • Identify patient assistance programs, copay cards, grants, or funds that could be utilized to reduce patient financial burdens
  • Communicate with the clinic to obtain additional information or guidance related to prior authorization submission
  • Assist clinics with submitting appeals related to coverage denials
  • Communicate determinations and relevant follow-up with patients on behalf of client, including :
  • Share information related to medication coverage and financial assistance options
  • Provide pharmacy options for where prescriptions can be filled
  • Ensure timely and accurate documentation related to services provided to clients and their patients by appropriately documenting information in client's EMR systems based on the agreed-upon Visante-client workflow and documenting information in Visante systems for tracking authorization volumes and associated fees
  • Support client with onboarding and training of client-employed medication access specialists, when directed and supporting Visante with continual process improvement and client-specific workflow and process development
  • Collaborate with Visante team members and leaders to provide insight and constructive feedback into day-to-day operations; lead implementation of improvements resulting from feedback
  • Support client with improving clinical staff and client pharmacy workflows and communications
  • Complete other duties as assigned by supervisor

Requirements

Education

Required :

  • High school diploma or equivalent
  • Experience

    Required :

  • Minimum 3 years of pharmacy experience in healthcare or with pharmacy providers focused on medication access
  • Preferred :

  • Prior consulting and / or client-facing experience
  • Experience with electronic medical record documentation and authorization workflows
  • Experience with performing retail pharmacy PBM adjudication
  • Experience in utilizing CoverMyMeds® to submit prior authorizations
  • Two (2) years of experience in healthcare revenue cycle that includes medication authorizations
  • Knowledge of CPT and ICD coding is highly desired
  • Knowledge of Medicare and third-party payer regulations and guidelines is highly desired
  • Two (2) years of experience in preadmission / precertification
  • Understanding health insurance and pharmacy insurance benefits investigation, health insurance terminology, billing, managed care contracting, and hospital reimbursement are highly desired
  • Licensure / Certification

    Required :

  • State Board of Pharmacy Technician registration obtained within 6 months of hire is required
  • Active CPhT certification through either PTCB or NHA preferred
  • Skills and Abilities

  • Exhibits good judgment, and ability to multi-task, prioritize, and meet deadlines with a sense of urgency with competing demands
  • Cultivates strong client relationships, interpersonal, and team skills
  • Demonstrates a proven ability to diagnose and resolve issues, exhibiting strong analytical and creative skills
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