Pharmacy Operations - Access Specialist

The Pharmacy Operations – Access Specialist will have strong knowledge of insurance, revenue cycle, pharmacy services and health system operations to work as a liaison between acute care, ambulatory sites, Fairview Home Infusion, and Fairview Specialty Pharmacy to coordinate patient care seamlessly across the organization.

This role will work as a part of an interdisciplinary team of revenue cycle, service line, clinicians, physicians, and other health care providers in a rewarding, fast-paced work environment in an academic/clinic setting. This position allows a high preforming, experienced pharmacy individuals expand their knowledge base.

• Perform verification of insurance benefits, analysis, payer policies, identify any potential access issues, and removing barriers to care across Fairview Pharmacy Services.
• Assist in resolving access issues with payers and provide information and expertise to other departments.
• Assess patients’ payor source and clinical information to identify appropriate site to provide care for patient (home infusion, outpatient infusion therapy, or specialty pharmacy) and coordinate with staff as appropriate.
• Screen patients for financial assistance eligibility by gathering financial information including income, assets, and estimates of charges for service, as appropriate.
• Support pharmacy services with requests from revenue cycle (coding, billing, etc.) regarding infusions and clinic administered medications.
• Maintain current knowledge of payer requirements and general admitting practices including use of on-line verification applications and initial and ongoing training.
• Coordination and authorization of payer mandated white bagging when required by MN State Law (not currently in effect).
• Understand all third party and Medicare/Medicaid regulations and billing guidelines as they pertain to pharmacy and medical benefits. Including Coordination of Benefits and copay assistance.
• Coordinate with outside facilities on prior authorization and access as needed for MHFV providers.
• Research to find other programs for payment and/or negotiate with providers and third-party payers to provide coverage or exceptions.
• Identify and escalate issues if deemed beyond scope.
• Partner with potential international and self-pay patients on any financial or service needs related to their pharmacy care.
• Provide financial counselling and support for patients as needed during their treatment communicating options for financial assistance as appropriate; answer related questions to ensure patients’ understanding of their benefits.
• Explain patient charges and/or insurance benefits (medical & pharmacy) and communicate expectations of financial responsibilities as it relates to access issues.
• Advising patients on route to access if unable to be serviced within FPS (limited distribution, payor carve out, benefit design, etc.)
• Expedite patient access to high-cost medications by identifying and resolving barriers on behalf of clinic care teams, including submitting and following prior authorizations/appeals, alternate funding for claim appeals, and assisting patients with financial assistance program on out-of-pocket costs.
• Understand the patient journey, support resources available, and strategies to shape ongoing patient relationships
• Communicate expectations, timing, and process capability to pharmacy, patients, caregivers, and clinics.
• Drug care coordination working with clinics and various Fairview Pharmacy Services teams to allow seamless transition and access to high-cost medications to allow for best patient experience.
• Meet with clinic staff regularly to foster relationship-building and represent Fairview Pharmacy Services.
• Assist care teams with Letters of Medical Necessity and maintain template library
• Coordinate with Care Teams on high level appeals across FPS (Court of Appeals).
• Act as an advocate for ambulatory pharmacy services, including, but not limited to specialty pharmacy, home infusion pharmacy, compounding pharmacy, acute care and explaining our offered services (all FPS locations).
• Use various reports and data across FPS to identify, support and implement changes to current processes to facilitate communication and service between patient, provider, and pharmacy teams to ensure accurate and timely delivery of care.
• Support Pharmacy Services and organization to on-board high-cost new drug therapies to ensure appropriate access for patients and education to appropriate FPS teams
• Work as Pharmacy Services Access expert to teach and train direct pharmacy staff on broad access issues (Subject Matter/Situational Expert and Educational resource for Pharmacy Services).
• Serve as a resource to the affiliations, staff, and physicians regarding Fairview Pharmacy Services. Assist with the coordination of services by communicating effectively and in a timely manner with others.
• Establish relationships with industry representatives and reimbursement managers to maintain current knowledge on available financial assistance programs

Required Qualifications

• B.S./B.A. in business or healthcare related field
• The ideal candidate will have experience in pharmacy, working with specialty infusion, home infusion, pharmacy medications, prior authorizations, and/or coordinating work with multiple stakeholders.
• Communication skills, interpersonal skills, adaptability are critical.
• Willingness to work in a fast-paced environment, work independently, to grow and develop, and to be an integral part of the team is necessary.
• 5 years of revenue cycle, financial counseling, pharmacy access services, or contracting experience in a healthcare or insurance organization.

Preferred Qualifications

• 5 years of revenue cycle, financial counseling, pharmacy access services, or contracting experience in a healthcare or insurance organization.
• Pharmacy Technician MN Registered as Pharmacy Technician with the MN State Board of Pharmacy.
• If Minnesota Board of Pharmacy registration on or after 1/1/2013, must have a certificate of completion from a MNBOP approved employer based or vocational/technical training program

$27.34- $38.59 Hourly