• Proactively contributes to Eskenazi Health’s mission: Advocate, Care, Teach and Serve with special emphasis on the vulnerable population of Marion County; models Eskenazi Health values of Professionalism, Respect, Innovation, Development and Excellence
• Assists with responsibility for implementation, documentation and maintenance of Eskenazi Health’s Medication Access Program (MAP)
• Contributes to maximizing revenue capture for high-cost clinic-administered and take-home medications by completing third party (external) medical benefit authorizations
• Works to maximize Eskenazi Health and patient participation in pharmaceutical company sponsored medication assistance programs – institutional, individual and foundation-based
• Continuously seeks new programs and opportunities for medication access
• Develops a thorough understanding of reimbursement policies and patterns for pharmacy claims with third parties and resolves discrepancies
• Communicates effectively with care teams and insurance companies as necessary to follow up on rejected claims, denials, or other barriers to therapy
• Triages, processes, and manages pharmacy prior authorization requests with diligent follow-up to patients and providers as appropriate
• Pre-screens patients for viable payment sources and educates care teams on outcomes and processes necessary to achieve coverage
• Analyzes payor responses and seeks available wraparound sources of support for patient therapy plans
• Identifies pathways to coverage for uninsured and underinsured patients
• Facilitates adherence by ensuring that patients receive prescribed medications and therapies in a timely manner
• Ensures medications can be physically obtained by patients through a variety of modalities (delivery, home delivery, mail delivery, pickup, etc.)
• Maintains multiple queues and portals, internal and external, that provide baseline functionality to operate medication access program (EHR, Prior Authorization request, Medicaid, specialty pharmacy, manufacturer, foundations, etc.)
• Identifies opportunities to improve reimbursement optimization and works collaboratively to develop and institute successful action plans
• Works in collaboration with care teams (physicians, nurses, clinical specialists, pharmacists, social workers, precertification analysts) to ensure patients are adequately triaged and monitored throughout therapy
• Trains or instructs staff members and peers on use of patient assistant programs and other programs or actions that affect the MAP
• Provides ongoing feedback to staff resulting from MAP quality assurance audits
• Collaborates with other care providers to promote a high standard of care