Job Description

GENERAL SUMMARY OF DUTIES

The Medication Access & Adherence Specialist plays a dual role in supporting timely medication access and improving patient health outcomes. This specialist is responsible for managing prior authorization (PA) processes while proactively engaging patients to promote medication adherence through outreach, education and follow-up.

SUPERVISION RECEIVED

Ambulatory Care Pharmacy Manager

SUPERVISION EXERCISED

None

ROLE AND RESPONSIBILITIES:

• Review, prepare, and submit prior authorization requests to insurance providers for prescribed medications
• Track authorization status and ensure timely follow-up to prevent delays in therapy
• Maintain accurate documentation of all PA activities in the appropriate systems
• Identify alternative therapies or solutions when coverage barriers arise
• Conduct outbound calls to patients to support medication adherence and persistence
• Educate patients on proper medication use as directed by provider and importance of adherence
• Identify barriers to adherence (cost, access, side effects, understanding) and provide solutions or escalate as needed
• Coordinate refills and reminders to ensure continuity of care
• Serve as a liaison between patients, providers, pharmacies, and insurance companies
• Assist with benefits investigation and financial assistance programs when applicable
• Support care teams with insights on patient adherence trends and access issues
• Attend and participate in organized functions of PHC and perform administrative duties as necessary.
• Other duties as assigned

Requirements

QUALIFICATIONS

• 2+ years of experience in prior authorization, healthcare support, pharmacy, or patient outreach
• Knowledge of insurance processes, formularies, and medication access workflows
• Strong communication and interpersonal skills, especially over the phone
• Experience with EMR/EHR systems and pharmacy platforms
• Ability to manage multiple tasks and work in a fast-paced environment
• Experience working with HEDIS quality measures is preferred.
• Experience in a clinical setting preferred
• Demonstrated skills in leadership, advocacy, and communication.
• Culturally effective capabilities demonstrating a sensitivity and responsiveness to varying cultural characteristics and beliefs.

KNOWLEDGE AND SKILL REQUIREMENTS:

• Self-motivated, dependable, strong work ethic with a desire to learn.
• Strong time and project management skills.
• Experience with computer applications with proficient excel abilities.
• Ability to apply critical thinking skills and make sound judgments both while performing daily responsibilities and throughout the patient’s continuum of care.
• Knowledge and demonstrated abilities to work in a regulatory climate that includes oversight by federal and state rules, payer contracts, governmental benefits, and community resources.
• Excellent oral and written communication skills.
• Excellent interpersonal skills reflecting clarity and diplomacy and the ability to communicate accurately and effectively with all levels of staff and management.
• Detail-oriented, thorough, and able to handle multiple tasks and projects with varying deadlines and priorities.
• Ability to work successfully in a fast-paced, stressful environment.
• Ability to work with a registry and an electronic health record.
• Empathy, mental alertness, precision, analytical problem-solving abilities, communication skills, focus, and initiative.
• Fundamental knowledge of healthcare organization, operations, and processes.
• Ability to lead, organize, and collaboratively work with a team to ensure department goals are met in a timely manner.

ENVIRONMENTAL/WORKING CONDITIONS:

• Talking, hearing, repetitive motions and close visual acuity associated with a normal office environment.
• Potential for a variety of exposure to additional work settings to include clinical/medical office, patient’s home, and/or a community-based environment.
• Dedicated home office space for remote work flexibility, as role is assigned/directed by a supervisor. If directed for remote work, the home office space must be of low distraction, HIPAA compliant, and supported by a reliable internet service to support system applications.

PHYSICAL/MENTAL DEMANDS:

• Standing, sitting for long periods while doing computer input and making phone calls.
• Must have ability to bend, stoop, twist and work with computer equipment.
• Stress involved in working with patients with multiple co-morbidities and multiple assignments.