VCU Health
Medication Access Specialist, Specialty Pharmacy
VCU Health, Richmond, Virginia, United States, 23214
Medication Access Specialist (MAS)
The Medication Access Specialist (MAS) is responsible for completing necessary functions to ensure timely medication access for high cost, self-administered or in-clinic administered medications. This role will provide resources to patients to minimize out of pocket cost while maximizing pharmacy reimbursement.
Essential Job Statements
Reviews prescription for accuracy of prescribed treatment regimen, complete data entry of prescription, adjudicate pharmacy claims, and resolve adjudication errors and rejections.
Completes pharmacy benefits investigation and coordination, initiates and completes prior authorization approval and/or denials (appeals), tracks progress, expediting responses from insurance carriers and payers, and coordinates additional assistance (as needed) with copay cards, grant funding, and patient assistance programs.
Participates in Specialty pharmacy call center activities and triage. The MAS is responsible for incoming calls from patients, payers, and providers to ensure pharmacy call response requirements are met for accreditation(s).
Facilitates adherence to medications by ensuring that patients receive prescribed medications in a timely manner. Documents and triages patient problems with therapy to the appropriate pharmacist; assures documentation of problem and follow-up with patient and assists with coordination of filling.
Enhances medication access by preventing therapy interruptions due to insurance issues in conjunction with pharmacists, physicians, and clinic staff. Communicates and collaborates regarding patient therapy interruptions, additional therapy monitoring requirements, and alternative care delivery setting options.
Expedites resolution of delivery and dispensing problems that may occur to ensure continued medication access.
Participates in the Specialty pharmacy quality management committee.
Mentors/Trains Assists in the orientation and/or instruction of new employees in the role of MAS.
Works as a Pharmacy Technician when deemed necessary.
Patient Population
Neonates (0-4 weeks)
Infant (1-12 months)
Pediatrics (1-12 years)
Adolescents (13-17 years)
Adults (18-64 years)
Geriatrics (65 years and older)
Required Education High School Diploma or equivalent Education/training
Preferred Education —
Licensure/Certification Required
Current certification by the Pharmacy Technician Certification Board (PTCB) OR valid ExCPT certification provided by the National Health Career Association
Current licensure with the Virginia State Board of Pharmacy
Clean criminal record (no felony conviction; no drug or pharmacy related convictions, including misdemeanors; no denial, suspension, revocation, or restriction of registration or licensure by any State Board of Pharmacy)
Licensure/Certification Preferred —
Minimum Qualifications Years and Type of Required Experience
Minimum of one (1) year previous pharmacy practice or Specialty pharmacy experience
Minimum of one (1) year of customer service or call-center experience
Other Knowledge, Skills and Abilities Required
Cultural Responsiveness – Respond respectfully and effectively to people of all cultures, languages, classes, races, ethnic backgrounds, disabilities, religions, genders, sexual orientations, and other diversity factors in a manner that recognizes, affirms, and values their worth.
Other Knowledge, Skills and Abilities Preferred
Minimum of one (1) year prior experience with prior authorizations, Patient Assistance Programs, and prior experience with prescription online adjudication.
Previous work experience using a personal computer and various billing software applications as well as e‑mail, spreadsheets, word processing, databases, etc.
Working Conditions Periods of high stress and fluctuating workloads may occur.
General office environment. May be exposed to high noise levels and bright lights.
May be exposed to limited hazardous substances or body fluids. *
May be exposed to human blood and other potentially infectious materials. *
May have periods of constant interruptions.
* Individuals in this position are required to exercise universal precautions, use personal protective equipment and devices, and learn the policies concerning infection control.
Physical Requirements Lifting/ Carrying (0-50 lbs.), Push/ Pull (0-50 lbs.), Stoop, Kneel, Squat, Bending
Work Position: Sitting, Walking, Standing
Additional Physical Requirements/ Hazards Manual dexterity (eye/hand coordination), Perform shift work, Hear alarms/telephone/tape recorder, Reach above shoulder, Repetitive arm/hand movements, Finger Dexterity, Color Vision, Acuity - far, Acuity - near
Hazards: Use of Latex Gloves, Exposure to moving mechanical parts, Exposure to high pitched noises
Mental/Sensory – Emotional Strong Recall, Reasoning, Problem Solving, Hearing, Speak Clearly, Write Legibly, Reading, Logical Thinking
Fast-paced environment, Able to Handle Multiple Priorities, Frequent and Intense Customer Interactions, Noisy Environment, Able to Adapt to Frequent Change
EEO Employer/Disabled/Protected Veteran/41 CFR 60-1.4.
#J-18808-Ljbffr
Essential Job Statements
Reviews prescription for accuracy of prescribed treatment regimen, complete data entry of prescription, adjudicate pharmacy claims, and resolve adjudication errors and rejections.
Completes pharmacy benefits investigation and coordination, initiates and completes prior authorization approval and/or denials (appeals), tracks progress, expediting responses from insurance carriers and payers, and coordinates additional assistance (as needed) with copay cards, grant funding, and patient assistance programs.
Participates in Specialty pharmacy call center activities and triage. The MAS is responsible for incoming calls from patients, payers, and providers to ensure pharmacy call response requirements are met for accreditation(s).
Facilitates adherence to medications by ensuring that patients receive prescribed medications in a timely manner. Documents and triages patient problems with therapy to the appropriate pharmacist; assures documentation of problem and follow-up with patient and assists with coordination of filling.
Enhances medication access by preventing therapy interruptions due to insurance issues in conjunction with pharmacists, physicians, and clinic staff. Communicates and collaborates regarding patient therapy interruptions, additional therapy monitoring requirements, and alternative care delivery setting options.
Expedites resolution of delivery and dispensing problems that may occur to ensure continued medication access.
Participates in the Specialty pharmacy quality management committee.
Mentors/Trains Assists in the orientation and/or instruction of new employees in the role of MAS.
Works as a Pharmacy Technician when deemed necessary.
Patient Population
Neonates (0-4 weeks)
Infant (1-12 months)
Pediatrics (1-12 years)
Adolescents (13-17 years)
Adults (18-64 years)
Geriatrics (65 years and older)
Required Education High School Diploma or equivalent Education/training
Preferred Education —
Licensure/Certification Required
Current certification by the Pharmacy Technician Certification Board (PTCB) OR valid ExCPT certification provided by the National Health Career Association
Current licensure with the Virginia State Board of Pharmacy
Clean criminal record (no felony conviction; no drug or pharmacy related convictions, including misdemeanors; no denial, suspension, revocation, or restriction of registration or licensure by any State Board of Pharmacy)
Licensure/Certification Preferred —
Minimum Qualifications Years and Type of Required Experience
Minimum of one (1) year previous pharmacy practice or Specialty pharmacy experience
Minimum of one (1) year of customer service or call-center experience
Other Knowledge, Skills and Abilities Required
Cultural Responsiveness – Respond respectfully and effectively to people of all cultures, languages, classes, races, ethnic backgrounds, disabilities, religions, genders, sexual orientations, and other diversity factors in a manner that recognizes, affirms, and values their worth.
Other Knowledge, Skills and Abilities Preferred
Minimum of one (1) year prior experience with prior authorizations, Patient Assistance Programs, and prior experience with prescription online adjudication.
Previous work experience using a personal computer and various billing software applications as well as e‑mail, spreadsheets, word processing, databases, etc.
Working Conditions Periods of high stress and fluctuating workloads may occur.
General office environment. May be exposed to high noise levels and bright lights.
May be exposed to limited hazardous substances or body fluids. *
May be exposed to human blood and other potentially infectious materials. *
May have periods of constant interruptions.
* Individuals in this position are required to exercise universal precautions, use personal protective equipment and devices, and learn the policies concerning infection control.
Physical Requirements Lifting/ Carrying (0-50 lbs.), Push/ Pull (0-50 lbs.), Stoop, Kneel, Squat, Bending
Work Position: Sitting, Walking, Standing
Additional Physical Requirements/ Hazards Manual dexterity (eye/hand coordination), Perform shift work, Hear alarms/telephone/tape recorder, Reach above shoulder, Repetitive arm/hand movements, Finger Dexterity, Color Vision, Acuity - far, Acuity - near
Hazards: Use of Latex Gloves, Exposure to moving mechanical parts, Exposure to high pitched noises
Mental/Sensory – Emotional Strong Recall, Reasoning, Problem Solving, Hearing, Speak Clearly, Write Legibly, Reading, Logical Thinking
Fast-paced environment, Able to Handle Multiple Priorities, Frequent and Intense Customer Interactions, Noisy Environment, Able to Adapt to Frequent Change
EEO Employer/Disabled/Protected Veteran/41 CFR 60-1.4.
#J-18808-Ljbffr